Delayed rupture of a renal artery pseudoaneurysm following blunt renal trauma in a 3-year-old child.

Blunt renal trauma in children is typically managed nonoperatively, but rare delayed vascular complications such as pseudoaneurysm rupture can be life-threatening. A 3-year-old girl sustained grade III right renal injury after a fall. Initial contrast-enhanced computed tomography (CECT) revealed a renal laceration without urinary extravasation but a large perirenal hematoma. The patient was treated conservatively and discharged on day 15 with no evidence of pseudoaneurysm on day 7 CECT. On post-injury day 22, the patient represented with gross hematuria and flank pain. CECT revealed rupture of a lower branch renal artery pseudoaneurysm. Emergency transcatheter arterial embolization with N-butyl-2-cyanoacrylate achieved complete hemostasis. Follow-up at 4 months confirmed no recurrence. This is the first reported case of traumatic renal artery pseudoaneurysm rupture in a child under 5 years. It illustrates that rupture can occur after early negative imaging during hematoma resorption. Vigilant follow up, preferably with ultrasonography, is warranted in pediatric renal trauma with large perirenal hematomas.