Spontaneous perinephric hematoma secondary to renal tumor

Abstract

1. 1. Two case reports of spontaneous perinephric hematoma secondary to renal tumor are presented. In the first patient, the hematoma was extracapsular and the tumor was large. The second patient had a subcapsular hematoma and the kidney appeared grossly normal. Microscopic examination revealed a small carcinoma in the cortex which was the cause of the bleeding. 2. 2. The etiology of spontaneous perinephric hematoma includes a multiplicity of disease processes, the more common being nephritis, renal tumors, renal artery aneurysm, arteriosclerosis and periarteritis nodosa. It is of interest that no renal disease could be demonstrated in a significant number of reported cases. 3. 3. The possibility of a renal tumor being the cause of the bleeding should be kept in mind since a spontaneous hematoma may be the first clinical sign of this lesion. 4. 4. The diagnosis of perinephric hematoma is rarely made since the clinical picture and pyelographic findings are not pathognomonic. It should be suspected in all patients with a history of pain in the flank and presence of a renal mass together with evidence of internal bleeding. The most important diagnostic feature is low or decreasing hemoglobin and hematocrit. 5. 5. The treatment of choice is nephrectomy which is often a life-saving procedure. However, whenever possible the status of the opposite kidney should be determined preoperatively since the underlying cause of the bleeding may be bilateral