Subepithelial pelvic hematoma of the kidney (Antopol-Goldman Lesion)

Abstract

Renal pelvic hematoma (Antopol Goldman lesion) is a rare but significant condition that may clinically mimick a renal or a pelvic neoplasm. Differential diagnosis and optimal treatment are still not known certainly. A 80-year-old male patient admitted to the emergency department with gross hematuria/clot retention and right flank pain. Magnetic resonance imaging (MRI) imaging revealed a filling defect in the right renal pelvis. Diagnostic flexible uretrorenoscopy was performed and a renal pelvic tumor was excluded. A 6 Fr double J (DJ) ureteral catheter was placed for 4 weeks while the patient was under an antifibrinolytic therapy. Filling defect was not detected at 3 rd month control MRI. During 6 months of the follow-up period, gross hematuria or any abnormal radiological finding was not encountered.

Antopol Goldman lesion: A case report

“…With only around 50 cases being reported in the literature, AGL remains a rare condition [1] . Most of the time, it has been used to describe renal pelvic hematoma, despite that renal calyces and proximal ureter involvement may rarely happen [ 7 , 8 ]. In our case, the hematoma occupied the lower calyx and the renal pelvic.…”

“…AGL can be easily mistaken with other serious pathologies, but it was managed with partial or complete nephrectomies in most cases [ 4 , 6 ]. Fortunately, the first AGL to be treated conservatively was reported in 2008 [8] . Nowadays, conservative management, watchful waiting alongside withdrawing and controlling offending factors such as diabetes mellitus, hypertension, hemophilia, amyloidosis, anticoagulants reversal, and others are becoming the mainstay of management [ 1 – 3 ].…”

“…This clinical presentation and the associated radiological findings on imaging modalities may be mistaken for renal tumors. Therefore, diverting the management toward more invasive, unnecessary surgeries, since such lesions are now managed conservatively, highlights the importance of diagnosing such lesions [ 5 – 8 ].…”

A Rare Case Mimicking Collecting System Tumor: Antopol-Goldman Lesion

“…Although it occurs in every age group regardless of gender, it is more common in the elderly. However, 1 neonatal case and a few cases in patients younger than 40 years old have also been reported (2,3). Although several factors are believed to be involved in the etiology, it has not been fully elucidated.…”

“…Medical history and especially radiological examination are supportive of the diagnosis in patients with AG lesions,, who present with hematuria. The most common symptoms of AG lesion are hematuria and flank pain (2,5). Unfortunately, diagnosing AG lesions with radiological methods alone is difficult.…”