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Detection of pseudoaneurysm after heminephrectomy with Tc-99m labeled red blood cell bleeding study.

A 5-year-old girl with a history of Wilm's tumor of the upper pole of the right kidney underwent upper pole heminephrectomy. She initially did well. Ten days postoperatively, she experienced an episode of hematuria and clot passage with a significant drop in hemoglobin and hematocrit, requiring one unit of packed red blood cells (RBCs). Work up for a renal source of the bleed included ultrasound, which failed to demonstrate the etiology of bleeding. The tagged RBC scan demonstrated a focal area of activity in the superior aspect of the resected kidney consistent with a pseudoaneurysm. This was confirmed on angiography. The patient subsequently underwent embolization of the pseudoaneurysm without complication.