Subcapsular Renal Hematoma: Three Case Reports and Literature Reviews

Abstract

Subcapsular renal hematoma (ScRH), albeit not a common entity in clinical practice, is a life-threatening condition when it is stopped naturally by the tamponade effect of the renal capsule. Renal tumors, renal vascular diseases, trauma and iatrogenic reasons are held responsible in the etiology. The affected patients present to emergency departments with the symptoms and sings comprising sudden onset flank pain, abdominal tenderness and hematuria. We presented in this paper three case reports related to ScRHs; the first with spontaneous ScRH; the second with the ScRH induced by anticoagulation therapy; and, the third with traumatic ScRH. We implemented conservative treatment in all of the patients. Moreover, we aimed, along with the current literature, to commence a discussion on the etiological reasons, the clinical presentation and the treatment approaches with regard to ScRH.

Massive, Spontaneous Ruptured Renal Subcapsular Haematoma Following Thrombolytic Therapy in Acute ST-Elevation Myocardial Infarction

“…Our literature search revealed only one other similar case, although this was following administration of recombinant Tissue Plasminogen Activator in a case of acute ischaemic cerebrovascular accident [11]. In the context of percutaneous intervention, there have been reports of renal hematoma following percutaneous transluminal stent placement in the renal artery (via direct perforation) and percutaneous coronary intervention via femoral-access (via plaque dislodgement at the aorto-renal junction, following catheter or guidewire passage, lacerating the aorta and dissecting into the perirenal space) [10,12,13].…”

FAST Exam to Diagnose Subcapsular Renal Hematoma

“…Subcapsular renal hematomas develop due to a hemorrhage within the kidney that is contained in the fibrous capsule. 2 As the hematoma ages, a restrictive fibrous capsule forms. A capsule is best visualized on CT or MRI.…”

“…4 A subcapsular hematoma may be caused by trauma, renal tumors, cystic diseases, hydronephrosis, systemic lupus erythematosus, polyarteritis nodosa, infections, anticoagulation therapy, or iatrogenic interventions such as hemodialysis, renal biopsy, surgical procedures and extra corporeal shock lithotripsy. 2 Ultrasound can be used as an adjunct imaging study to provide an accurate, non-invasive and cost-effective diagnosis of a subcapsular renal hematoma. Color doppler should be utilized to identify ischemia and compression of the renal parenchyma.…”

Spontaneous Perinephric Haemorrhage (Wunderlich Syndrome) Secondary to Upper Pole Renal Angiomyolipoma: A Rare Life Threatening Situation: Case Report and Discussion

“…It is also frequently found in association with hypertension [4]. Classically, Wunderlich Syndrome is described by the presence of Lenk's triad which constitutes acute flank/lumbar pain, palpable tender mass and features of active internal bleed like hypotension, tachycardia and anaemia [7]. Clinically however, this triad is rarely seen and commonly presents with abdominal pain ISSN: 2332-4120 (67%), haematuria (40%) and hypovolemic shock (26.5%) [4].…”

“…Spontaneous renal haemorrhage is often detected by imaging while searching for other causes of lumbar pain and hypotension. Ultrasonography being quick and inexpensive is generally accepted first choice of investigation [7]. A Computed Tomography is considered the gold standard in establishing the diagnosis and often elucidates the underlying etiology attributing to this condition [6].…”