Subcapsular renal hematoma after shock wave lithotripsy

Abstract

76-year-old man presented to our Emergency Departent with a chief complaint of right flank pain. The atient stated that he had a history of a kidney stone and hat 3 h prior he had undergone extracorporeal shock ave lithotripsy (ESWL) of the right kidney. Before the rocedure the patient reported only mild pain in the ank, but since the procedure his pain had become much ore severe. The patient denied nausea, vomiting, chest ain, or shortness of breath. He had no fevers and denied ematuria. His past medical history was significant for iabetes mellitus, coronary artery disease, and emphyema in addition to nephrolithiasis. His medications inluded insulin, aspirin, rofecoxib, Glucophage, clopiogrel, and cetirizine. Physical examination revealed an elderly man in modrate distress due to pain. Vital signs were: temperature 6.4°C (97.6°F), blood pressure 123/66 mm Hg, heart ate 65 beats/min, and respiratory rate 18 breaths/min. he heart was regular without murmurs and lungs were lear to auscultation. The abdomen was soft and nonender to palpation. There was no hepatosplenomegaly. ack examination revealed right flank percussion tenderess at the costovertebral angle. No bruising was present. he remainder of the physical examination was normal. The patient received morphine 8 mg i.v. for pain. aboratory studies revealed hemoglobin of 13.1 g/dL nd a white blood cell count of 14 K/UL. Urinalysis was ignificant for 100–150 red blood cells. Due to continued