Spontaneous Perinephric Hemorrhage: Imaging and Management

Abstract

We report on 10 patients with spontaneous perinephric hemorrhage associated with underlying disease, including renal cell carcinoma (5), angiomyolipoma (2), malignant melanoma (1), periarteritis nodosa (1) and severe portal hypertension (1). The etiology could not be identified with computerized tomography (CT) in 5 cases (50%), including 2 renal cell carcinomas, 1 angiomyolipoma, 1 periarteritis nodosa and 1 portal hypertension. Arteriography demonstrated underlying lesions in 4 of these 5 cases (80%) including the case of vasculitis. CT combined with magnetic resonance imaging is accurate for the diagnosis of spontaneous perinephric hemorrhage but the underlying pathological condition is often undetectable in the acute phase due to the perinephric blood. CT should be the first study performed if this diagnosis is suspected. Arteriography is recommended if a renal mass is not detected. If a mass is not identified with these 2 imaging studies and the patient is clinically stable, followup thin slice CT should be performed.

Flank Pain, Nausea, Vomiting and Hypotension in a Chronic Hemodialysis Patient with a Spontaneous Perirenal Hemorrhage

“…Conversely, one may argue that the patients with such disease can be followed carefully and noninvasively with recurrent radiological studies, such as CT scanning, thus suggesting that aggressive surgical intervention is not justified (14, 30). In our patient, it was difficult to pre-cisely evaluate her for the presence of renal carcinoma by imaging techniques due to the hemorrhagic nature of the kidney (30,31). Therefore, a radical nephrectomy was finally performed despite achieving successful bleeding control by consecutive rounds of renal arterial embolization.…”

Successful non-surgical treatment on bilateral spontaneous perirenal giant hematomas in rapidly progressive glomerulonephritis with MPO-ANCA positive

“…Spontaneous subcapsular or perirenal hemorrhage is a relatively uncommon complication that often requires additional treatment [3,4]. A total of 165 patients with this complication were reported between 1985 and 1999 [5].…”

Subcapsular Renal Hematoma: Three Case Reports and Literature Reviews

“…A perirenal hematoma can be confused ultrasonographically with a renal tumor or an abscess formation, at which point abdominal CT can be used to confirm the suspected diagnosis. A sizable number of medical studies indicated CT to be more sensitive than USG in making the diagnosis of ScRH [16,17]. In such situations as presence of contrast allergy and pregnancy when CT is considered to be contraindicated, alternative modes of imaging such as magnetic resonance imaging can be implemented.…”