Spontaneous perirenal hemorrhage in hemodialysis patient treated with selective embolization: A case series and review of the literature

Xie, Yun; Yang, Bo; Jiang, Gengru; Lü, Wei; Ronco, Claudio

doi:10.1111/hdi.12607

Cited by 7 publications

(8 citation statements)

References 28 publications

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“…26 It is known that patients with chronic kidney disease who undergo haemodialysis have a predisposition to platelet dysfunction and bleeding secondary to endothelial abnormalities. 27,28 Among our cases, WS developed due to coagulopathy in one patient after coronary angiography and in another patient that was receiving haemodialysis.…”

Section: Discussionmentioning

confidence: 78%

Computed Tomography Findings in Wunderlich Syndrome

Emekli

Gündoğdu

2022

Hong Kong Journal of Radiology

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Background: Wunderlich syndrome (WS) is defined as renal/perirenal haemorrhage in the absence of trauma. Causative factors include neoplasms, vascular abnormalities, cystic kidney diseases, and coagulation disorders. Computed tomography (CT) is the diagnostic method of choice in the diagnosis of WS. We aimed to investigate CT findings, aetiologies, demographic features, and treatment outcomes in a group of patients diagnosed with WS. Methods: We retrospectively reviewed 113 patients found to have renal-perirenal hematoma on CT between January 2015 and January 2020, and excluded 101 cases with a history of trauma or renal biopsy. The remaining 12 patients constituted the study group. Results: Five (41.7%) of the 12 patients included in the study were female and seven (58.3%) were male. The mean age was 53.2 years (range, 7-81). CT revealed mass lesions in seven (58.3%), a pseudoaneurysm in two (16.7%), and renal vein thrombosis in one (8.3%) patient. Two of the mass lesions (28.6%) detected on CT were angiomyolipomas, one (14.3%) was a haemorrhagic cyst in a patient with adult polycystic kidney disease, and four (57.1%) were solid mass lesions. Three of the four patients with masses were surgically treated. All pseudoaneurysms, the single inoperable solid mass, and one of the angiomyolipomas were treated angiographically. Conclusion: WS is an acute urological emergency with multiple possible aetiologies, some of which are more likely to require surgical management. CT is important in the diagnosis and management of the syndrome to identify haemodynamically unstable cases in need of immediate intervention.

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Section: Discussionmentioning

confidence: 78%

Computed Tomography Findings in Wunderlich Syndrome

Emekli

Gündoğdu

2022

Hong Kong Journal of Radiology

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“…While patient vital signs are paramount, the diagnosis of SRH cannot be made in the absence of imaging and the presence of active extravasation on CT should also guide initial management. If the patient presents with unstable vital signs or active extravasation on imaging then angiogram with embolization is indicated after appropriate stabilization [ 9 - 10 ]. Overnight observation with conservative management, or even outpatient management with close clinical follow-up, may be appropriate if vital signs are stable and no active extravasation is observed on imaging.…”

Section: Discussionmentioning

confidence: 99%

“…Selective arterial embolization is another method to control active bleeding, particularly in hemodynamically unstable patients [8]. Many authors recommend embolization as the definitive therapy given strong evidence supporting its efficacy in cases of both traumatic and non-traumatic renal hemorrhage and relatively low-risk profile [6,[9][10][11]. However, some authors still consider embolization as a temporizing measure and second line to nephrectomy [6].…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Renal Hemorrhage: A Case Report and Clinical Protocol

Antonescu¹,

Duhamel²,

Giacinto³

et al. 2021

Cureus

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Spontaneous renal hemorrhage is an uncommon entity with potentially serious consequences. We present a 68-year-old female with a three-day history of progressively worsening left-sided flank pain due to spontaneous left renal hemorrhage without a history of trauma or anticoagulation. The patient's symptoms improved with conservative management and she was discharged after several days of observation. However, the patient was readmitted the next day with progressively worsening pain due to hematoma expansion from active extravasation. On the second admission, interventional radiology successfully embolized the affected vessels and the patient improved rapidly. The hematoma decreased in size on followup exams but no etiology was discovered. Early arterial embolization may have improved outcomes in this case and we argue that it should be considered early in the management of all patients with spontaneous renal hemorrhage.

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“…Spontaneous perirenal hemorrhage is a less frequent yet very important symptom of RCC. A study by Zhang et al showed that for >50% of patients with unclear causes of perirenal hematoma, an asymptomatic renal tumor will be identified, most often AML or RCC [ 23 , 24 ]. Performing a CT after a few months helps establishing a definitive diagnosis.…”

Section: Semiology and Natural Evolution Of Rccsmentioning

confidence: 99%

Contemporary Clinical Definitions, Differential Diagnosis, and Novel Predictive Tools for Renal Cell Carcinoma

Novacescu

Feciche²,

Cumpanas

et al. 2022

Biomedicines

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Despite significant progress regarding clinical detection/imaging evaluation modalities and genetic/molecular characterization of pathogenesis, advanced renal cell carcinoma (RCC) remains an incurable disease and overall RCC mortality has been steadily rising for decades. Concomitantly, clinical definitions have been greatly nuanced and refined. RCCs are currently viewed as a heterogeneous series of cancers, with the same anatomical origin, but fundamentally different metabolisms and clinical behaviors. Thus, RCC pathological diagnosis/subtyping guidelines have become increasingly intricate and cumbersome, routinely requiring ancillary studies, mainly immunohistochemistry. Meanwhile, RCC-associated-antigen targeted systemic therapy has been greatly diversified and emerging, novel clinical applications for RCC immunotherapy have already reported significant survival benefits, at least in the adjuvant setting. Even so, systemically disseminated RCCs still associate very poor clinical outcomes, with currently available therapeutic modalities only being able to prolong survival. In lack of a definitive cure for advanced RCCs, integration of the amounting scientific knowledge regarding RCC pathogenesis into RCC clinical management has been paramount for improving patient outcomes. The current review aims to offer an integrative perspective regarding contemporary RCC clinical definitions, proper RCC clinical work-up at initial diagnosis (semiology and multimodal imaging), RCC pathological evaluation, differential diagnosis/subtyping protocols, and novel clinical tools for RCC screening, risk stratification and therapeutic response prediction.

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Spontaneous perirenal hemorrhage in hemodialysis patient treated with selective embolization: A case series and review of the literature

Cited by 7 publications

References 28 publications

Computed Tomography Findings in Wunderlich Syndrome

Computed Tomography Findings in Wunderlich Syndrome

Spontaneous Renal Hemorrhage: A Case Report and Clinical Protocol

Contemporary Clinical Definitions, Differential Diagnosis, and Novel Predictive Tools for Renal Cell Carcinoma

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