Spontaneous Perinephric Hemorrhage Research Articles

Acute Flank Pain, Flank Mass and Hypovolemic Shock due to Kidney Cysts Rupture: An Emblematic Case of Wunderlich Syndrome

Spontaneous perinephric hemorrhage (SPH) due to kidney cysts rupture is uncommon compli- cation but when it occurs can cause an emergency situation that may endanger the patient's life. Wunderlich first described the condition of spontaneous, non-traumatic renal bleeding confined to the subcapsular and perirenal spaces. Herein, we report a case of Wunderlich syndrome (WS) due to spontaneous rupture of a simple kidney cyst. In our case, the spontaneous retroperito- neal hemorrage (SRH) was associated to a probable giant haemorragic cyst that is uncommon since cyst rupture occurs into caliceal system rather than the perinephric space. Wunderlich syndrome after spontaneous, non-traumatic kidney cyst rupture is a rare entity. A multimodal- ity approach is necessary to a have a definitive diagnosis in order to choose the best treatment possible for the patient.

Aetiology, imaging features, and evolution of spontaneous perirenal haemorrhage

To evaluate the aetiology, imaging features, and the evolution of spontaneous perirenal haemorrhage detected by imaging. In this retrospective study, the hospital database was searched for all cases of spontaneous perinephric haemorrhage detected by imaging between January 2000 and December 2012. Imaging examinations were reviewed and the following parameters were recorded: the location, extension, and total volume of the haematoma, presence of active extravasation, the haematocrit effect, and highest density. The resolution time was calculated using follow-up imaging. The final aetiology for all cases was assessed via clinical, radiological, and histopathological data. Differences in imaging features of haemorrhage according to aetiology group were analysed with independent samples test and Fisher's exact test. Eighty-one haematomas were identified in 78 patients during this 13-year period. Causes of perirenal haemorrhage included coagulation disorders (22/81, 27.1%), ruptured renal cyst (11/81, 13.6%), rupture of abdominal aortic aneurysm (9/81, 11.1%), renal cell carcinoma (9/81, 11.1%), adrenal masses (9/81, 11.1%), polycystic kidney disease (7/81, 8.6%), angiomyolipoma (6/81, 7.4%), renal vascular diseases (2/81, 2.4%), and recurrent pyelonephritis (1/81, 1.2%). Haematomas associated with coagulation abnormalities and vascular diseases presented with larger volumes and were more likely to extent to the pararenal space more so than other groups; ruptured renal cyst and renal cell carcinomas tended to be more associated with subcapsular haematomas. The haematocrit effect and haemorrhage involving renal parenchyma were more often observed in the group with coagulation abnormalities. Imaging features, such as location and extension, could help radiologists identify possible aetiologies of spontaneous perirenal haemorrhage.

Spontaneous perinephric haemorrhage in an end‐stage renal disease patient with multiple renal pseudoaneurysms

Spontaneous perinephric haemorrhage in an end‐stage renal disease patient with multiple renal pseudoaneurysms

Wünderlich Syndrome From Lupus-Associated Vasculitis

Spontaneous perinephric hemorrhage is a clinically rare life-threatening condition, also known as Wünderlich syndrome. Presentations can be variable, but patients typically display symptoms and signs including flank or abdominal pain, abdominal mass, and hypovolemia. It is important to diagnose the syndrome early because untreated cases carry a high mortality risk, and prompt intervention with an endovascular procedure or surgery is life saving. Causes range from anatomical anomalies, including vascular diseases (vasculitides and aneurysms) and renal tumors, to functional coagulation defect (bleeding tendency). The most common causes of Wünderlich syndrome are renal angiomyolipoma and renal cell carcinoma, constituting 60%~70% of cases. Vascular causes of Wünderlich syndrome are infrequent, and the culprit most frequently is vasculitis resulting from polyarteritis nodosa. Other vasculitides presenting as Wünderlich syndrome are infrequent. We describe a 39-year-old woman with end-stage renal disease from lupus nephritis and spontaneous renal hemorrhage, ascribed to lupus-related vasculitis after serologic testing, computed tomography, and angiographic studies.

Page kidney in a patient with granulomatosis with polyangiitis (Wegener's)

Page kidney results from a perirenal haematoma or a mass around the kidney, which causes extrinsic compression on the renal parenchyma and is a very rare cause of secondary hypertension.1...

Spontaneous perinephric haemorrhage and acute renal failure in pregnancy due to cocaine intoxication.

Cocaine abuse may contribute to the diverse forms of renal injury. We report a case of a pregnant woman who developed a large subcapsular renal haematoma after cocaine intoxication at 18-week gestation. She stabilized on conservative management and presented again at 29-week gestation with pre-eclampsia, acute renal failure and fetal demise. She required caesarean section delivery and intensive antihypertensive therapy to control severe pre-eclampsia associated with cocaine intoxication. This case is unique in that it is the first report of cocaine intoxication in pregnancy complicated by subcapsular haemorrhage. We discuss the possible mechanisms for the occurrence of this complication.

Spontaneous Perinephric Hemorrhage from a Hemorrhagic Renal Cyst

Spontaneous Perinephric Hemorrhage from a Hemorrhagic Renal Cyst

Endovascular control of haemorrhagic urological emergencies: an observational study

BackgroundTransarterial embolisation (TAE) is an effective method in control of haemorrhage irrespective of the nature of urological emergency. As the technique and technology have evolved, it is now possible to perform highly selective embolisation. The aim of this study was to critically appraise feasibility and efficacy of therapeutic TAE in control of haemorrhagic urological emergencies using selective and non-selective embolisation. Specifically, we aimed to assess the impact of timing of embolisation on the requirement of blood transfusion and long-term morphological and functional follow-up of embolised organs.MethodsThis is a single institutional observational study carried out between March 1992 and March 2006. Records of all patients who underwent selective and non-selective angioembolisation to control bleeding in urological emergencies were reviewed. Data on success rate, periprocedural complications, timing of embolisation, requirement of blood transfusion and the long-term morphological and functional outcomes of embolised organs was recorded.ResultsFourteen patients underwent endovascular control of bleeding as a result of trauma, iatrogenic injury and spontaneous perinephric haemorrhage during a period of 14 years. All these patients would have required emergency open surgery without the option of embolisation procedure. The mean time between the first presentation and embolisation was 22 hours (range 30 minutes to 60 hours). Mean pre-embolisation transfusion requirement was 6.8 units (range 0–22 units). None of the patients with successful embolisation required post-procedural blood transfusion. Permanent haemostasis was achieved in all but one patient, who required emergency nephrectomy. There were no serious procedure related post-embolisation complications.ConclusionEndovascular control using transarterial angioembolisation is an effective method for managing haematuria or haemorrhage in urological emergencies. Wherever and whenever indicated, this option should be considered early in the management of these cases.

Spontaneous perinephric hemorrhage associated with urolithiasis in pregnancy.

Spontaneous perinephric hematoma in the absence of anticoagulation, arteritis, or trauma is uncommon. We report the case of a postpartum patient with nephrolithiasis who initially presented to the obstetric service with a spontaneous perinephric hemorrhage.

Etiology Of Spontaneous Perirenal Hemorrhage: A Meta-Analysis

Etiology Of Spontaneous Perirenal Hemorrhage: A Meta-Analysis

Spontaneous perinephric hemorrhage: imaging and management.

Spontaneous perinephric hemorrhage: imaging and management.

Perinephric hemorrhage secondary to adrenal myelolipoma case report

Spontaneous perinephric hemorrhage has been described as occurring secondary to a number of primary renal abnormalities, but rarely from other causes. We describe the computed tomography (CT) and ultrasound findings of this event resulting from hemorrhage from an adrenal myelolipoma.

Spontaneous Perinephric Hemorrhage: Imaging and Management

We report on 10 patients with spontaneous perinephric hemorrhage associated with underlying disease, including renal cell carcinoma (5), angiomyolipoma (2), malignant melanoma (1), periarteritis nodosa (1) and severe portal hypertension (1). The etiology could not be identified with computerized tomography (CT) in 5 cases (50%), including 2 renal cell carcinomas, 1 angiomyolipoma, 1 periarteritis nodosa and 1 portal hypertension. Arteriography demonstrated underlying lesions in 4 of these 5 cases (80%) including the case of vasculitis. CT combined with magnetic resonance imaging is accurate for the diagnosis of spontaneous perinephric hemorrhage but the underlying pathological condition is often undetectable in the acute phase due to the perinephric blood. CT should be the first study performed if this diagnosis is suspected. Arteriography is recommended if a renal mass is not detected. If a mass is not identified with these 2 imaging studies and the patient is clinically stable, followup thin slice CT should be performed.

Spontaneous perinephric and subcapsular renal hemorrhage: evaluation with CT, US, and angiography.

Eighteen consecutive patients with acute spontaneous perinephric hemorrhage were examined with computed tomography (CT) (n = 18), ultrasonography (US) (n = 15), and angiography (n = 9). Renal cell carcinoma was found in 10 patients; angiomyolipoma, three; and segmental renal infarction, arteriovenous malformation (AVM), hemorrhagic cyst, abscess, and idiopathic hemorrhage, one each. Initial CT examinations demonstrated the extent of hemorrhage in all cases and a distinct mass in 12 (67%), with CT characteristics suggestive of the correct diagnosis in 11. In the other six patients (33%), a discrete mass was not seen at initial CT, and in five cause of hemorrhage was not clear. Two of the five underwent follow-up CT, which correctly demonstrated carcinoma in both. Overall, CT findings suggested the correct diagnosis in 14 patients (78%). US was sensitive for detection of an abnormality but nonspecific as to its nature. Angiography demonstrated unsuspected AVM in one patient, segmental renal infarction seen at CT in one, but only one of five carcinomas suspected at CT. Data from this study suggest that CT is the most valuable examination for patients with spontaneous renal hemorrhage.

Spontaneous perinephric hemorrhage from extrarenal angiomyolipoma

We believe this is the first reported case of spontaneous perinephric hemorrhage arising from an extrarenal angiomyolipoma. To date there have been no cases reported of extrarenal angiomyolipoma associated with tuberous sclerosis. All extrarenal angiomyolipomas have been benign and treated with simple excision.

Spontaneous Perinephric Hemorrhage in a 65-Year-Old Man

Spontaneous Perinephric Hemorrhage in a 65-Year-Old Man