Fig. 1. Figure 1. Film taken in 1991.	Fig. 2. Film taken in 1991.

Case Reference No. CC-397-04 This 42-year-old man developed a CT scan documented segmental left renal infarct in1991. An arteriogram at that time showed a small peripheral aneurysm in the left kidney (Fig. 1) and a short segment of either ulceration or dissection in the main right renal artery (Fig 2). In 1997, he presents with a new left renal infarct. His arteriogram shows large left main and peripheral renal artery aneurysms with stenoses and occlusions of the upper and mid branches to the left kidney (Fig 3.). Accounting for magnification differences, his aortogram demonstrates interim enlargement of the aorta and iliac arteries (Figs. 4,5). There is also aneurysmal dilatation of the proximal splenic artery. His sedimentation rate and physical examination are normal. He has no other illnesses. He does not and has not used intravenous drug.

Fig. 3. Film taken in 1997.

Fig. 4. Film taken in 1991.

Fig. 5. Film taken in 1997.

Questions 1) What diagnoses may explain these findings? 2) What therapies are appropriate? 3) What other studies or tests should be obtained?