Spontaneus Suburothelial Hemorrhage Associated With Forniceal Rupture and Retroperitoneal Hemorrhage

Abstract

Spontaneous suburothelial hemorrhage is a rare process of unclear pathologic etiology, although it has been associated with bleeding diathesis and anticoagulation. The most common clinical presentation is acute onset flank pain and macroscopic hematuria. On imaging, there is a mural thickening of the renal pelvis and upper ureters leading to luminal narrowing. Despite luminal narrowing, hydronephrosis has only rarely been reported in the association. The imaging finding of mural thickening has led to the misdiagnosis as malignancy, resulting in unnecessary nephrectomy. Suburothelial hemorrhage can be unilateral or bilateral, although the majority of reported cases are unilateral. We present a case of a patient with bilateral spontaneous suburothelial hemorrhage with forniceal rupture and spontaneous retroperitoneal hemorrhage, a unique triad compared to prior cases presented in the literature.

Antopol Goldman lesion: A case report

“…In our case, the hematoma occupied the lower calyx and the renal pelvic. Most reported cases were unilateral, affecting the elderly without propensity toward gender or specific side [ 3 , 4 ]. However, the patient in our case was 17 years old, considered much younger than the age that AGL patients present in [4] .…”

“…Furthermore, as in our case, hematuria and flank pain are considered characteristics of patients with AGL, as they are found in most cases with minor differences in their character [ 2 , 6 ]. Meanwhile, spontaneous bleeding from other places, such as the nose or oral mucosa, is not commonly encountered in patients [4] . However, episodes of epistaxis were present in our case several years prior to the onset of hematuria.…”

“…As it was challenging to distinguish AGL from renal and collecting system tumors based on imaging techniques, histopathological examination after nephrectomy was the diagnostic modality at the beginning [ 3 , 4 ]. Due to this, many unnecessary nephrectomies were done for patients with AGL [ 1 , 6 ].…”

“…Imaging modalities may demonstrate a filling defect, mural thickening, and luminal narrowing of the renal pelvis and proximal ureters, which may be misdiagnosed as a tumor. However, hydronephrosis is rarely found [ 4 , 5 ].…”

“…It is described as a renal pelvis subepithelial hematoma or hemorrhage [ 1 , 2 ]. However, it may involve the renal calyces and proximal ureter [ 3 , 4 ]. Although several factors, such as excessive analgesic or anticoagulant medication use, diabetes mellitus, hypertension, hemophilia, etc., were linked to the development of this lesion, the definitive cause is not well established yet [ 1 , 5 ].…”