We present a 28 year old lady, para 2 that had a normal vaginal delivery. In the days following birth she presented to triage on several occasions with left flank pain, fainting episodes and haematuria. At her first two admissions her symptoms were labelled as secondary to “anxiety and possible urinary tract infection, with moderate lochia”. On her third admission, 8 days postnatally, it was noted her haemoglobin dropped from 100 to 63g/L. An ultrasound was performed which suggested a mass in the bladder suggestive of clots. This was followed by a CT scan which revealed a 4cm x 2cm lesion in the left renal pelvis continuous with the left renal artery, suggestive of a pseudo aneurysm. This was associated with moderate hydronephrosis and retroperitoneal haematoma.
The patient denied any history of trauma or renal problems. At a multidisciplinary team meeting it was discussed whether embolization or stenting should be performed. A stent was placed to occlude the opening of the pseudo aneurysm. Following the procedure her symptoms resolved and maintained her haemoglobin levels. A follow up appointment with CT angiogram revealed the aneurysm had thrombosed and the retroperitoneal haematoma had resolved.
With women attending repeated times for the same symptoms it is important to consider a wider differential diagnosis, and appropriate speciality involvement sought.
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