Pelvi-calyceal Cast Formation and Renal Artery Pseudoaneurysm Complicating Silver Nitrate Instillation for Chyluria: A Clinical Radiologist Perspective

Abstract

We report an unusual case of radiopaque pelvi-calyceal cast formation and intrarenal artery pseudoaneurysm following ureteroscopic instillation of 1% silver nitrate for chyluria. These dual rare complications with immediate and delayed onset, respectively, were identified on different radiology modalities in the same patient and have not been reported earlier. The pseudoaneurysm was successfully managed through endovascular coil embolisation. While a version of this case was previously published with different clinical emphasis by a different department, our manuscript presents critical findings not included in that report—namely, delayed presentation and cast formation. There are a few other significant radiological findings not reported in the earlier version which may help in understanding the pathogenesis of pseudoaneurysm formation. The discrepancy in the two manuscripts may be attributed to differences in departmental focus; it is also plausible that, in an increasingly competitive academic environment, the urgency to report a rare vascular complication led to the inadvertent omission of very obvious concurrent imaging findings. Our manuscript offers a more complete radiological-clinical correlation. It reinforces the importance of detailed history taking and careful study of the radiology images, thereby providing many valuable teaching points to postgraduate students.