Spontaneous Perirenal Hematoma Research Articles

RELATO DE CASO: HEMATOMA PERIRRENAL ESPONTÂNEO – SÍNDROME DE WUNDERLICH

Wunderlich syndrome (WS), also known as spontaneous perirenal hematoma (SPH), is a rare disease characterized by spontaneous hemorrhage in the subcapsular and perirenal spaces. We present a case of WS, in which a patient with developmental delay presented spontaneously to the medical center, due to pain in the right hypochondrium associated with hyporexia, vomiting, skin pallor and tachycardia. Computed tomography showed a large perirenal hematoma on the right. The patient evolved with hemodynamic instability, requiring right nephrectomy.

Endometriosis intratumoral en angiomiolipomas renales asociados a vasculitis necrosante de vaso mediano en una paciente con síndrome de Wünderlich: descripción de un hallazgo inusual

Spontaneous perirenal hematoma or Wünderlich syndrome is a rare entity that requires urgent attention. The most frequent causes are renal neoplasms, mainly renal angiomyolipoma, and vascular diseases (vasculitis). We present a case of a woman with a history of renal angiomyolipomas associated with tuberous sclerosis complex, who developed Wünderlich's syndrome associated with medial vessel vasculitis as well as an uncommon instance of intratumoral endometriosis.

Ruptura espontânea da veia renal em gestante: um relato de caso

Spontaneous perirenalhematoma are serious conditions that demand immediate attention. Although they have been described in the scientific literature since the late nineteenth century, its etiology is not fully understood. The present study reports the case of a 34 year-old patient, 39 weeks pregnant, that had been admitted complaining of acute abdominal pain. Physical examination was unremarkable, as well as the examination of transabdominal ultrasound. Her condition worsened later and she was referred to the operating room for emergency cesarean section for suspected placenta previa. She was identified then hemoperitoneum with bulky retroperitoneal hematoma on the right side.

Perirenal hematoma in a patient treated with bevacizumab for metastatic colon cancer: A case report.

The present study reports the case of a patient that developed spontaneous perirenal hematoma during treatment with bevacizumab-containing chemotherapy. A 44-year-old woman with metastatic sigmoid colon cancer, who was being treated with bevacizumab (5 mg/kg, intravenous, 90 min biweekly), was admitted to hospital following 3 cycles of chemotherapy, with a sudden onset of dyspnea and oliguria. An emergency hemodialysis was performed and a large right perirenal hematoma was diagnosed using computed tomography. The patient was immediately instructed to discontinue chemotherapy, including bevacizumab. However, the right perirenal hematoma increased in size and a left perirenal hematoma developed 3 weeks later. The two perirenal hematomas stabilized 7 weeks subsequent to the termination of bevacizumab treatment. Spontaneous perirenal hematoma due to bevacizumab treatment is an extremely rare occurrence. However, physicians should be aware of this potential complication associated with bevacizumab treatment.

Epithelioid angiomyolipoma of the kidney: Radiological imaging

To review the imaging findings of renal epithelioid angiomyolipomas. Eight patients treated at two institutions were pathologically diagnosed as having epithelioid angiomyolipoma. All of them underwent computed tomography, and four underwent magnetic resonance imaging. The tumor size, existence of fat, heterogeneity, computed tomography attenuation, degree of enhancement, enhancement pattern and magnetic resonance imaging signal intensity were evaluated. Intratumoral fat was not detected in any of the cases. On unenhanced computed tomography, the intratumoral attenuation was hyperattenuating in six of the seven patients who were examined using this modality. On T2-weighted images, the signal intensity of the solid component, cyst wall or septum was low in three of the four cases. Four of the eight cases were heterogeneous solid-type accompanied by hemorrhage, necrosis or hyalinization. One homogeneous solid-type lesion was large in size and was pathologically accompanied by neither hemorrhage nor necrosis. All three multilocular cystic types were pathologically accompanied by massive hemorrhage in the cystic component. One was accompanied by spontaneous perirenal hematoma. The radiological appearance of most epithelioid angiomyolipomas has a tendency to be hyperattenuating on unenhanced computed tomography images, with low intensities on T2-weighted images. They can be heterogeneously solid, homogeneously solid or a multilocular cystic lesion with massive hemorrhage.

Spontaneous perirenal hematoma in a lupic patient on haemodialysis treatment and with renal cysts

The spontaneous perirenal hemorrhage usually presents as sudden pain in the side ipsilateral, no history of trauma. Acquired cystic kidney disease is a common finding in chronic hemodialysis patients. However, spontaneous bleeding from the rupture of the cyst is a rare clinical entity. We describe the case of a female patient, 45 years old, with controlled hypertension for 8 years, chronic renal failure for 15 years and lupus nephritis 2 years ago, undergoing hemodialysis three times a week since 2006, and who presented concurrently acquired cystic kidney disease. She was admitted to the emergency department complaining of sudden onset of pain in the thoraco-abdominal left. Perirenal hematoma was diagnosed by ultrasound and computed tomography of the abdomen. The patient underwent embolization of left renal artery, with good evolution.

Spontaneous perirenal hematoma due to multiple renal artery aneurysms in a patient with presumed polyarteritis nodosa

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that involves the renal and visceral arteries.1 PAN typically presents with systemic symptoms and signs such as fatigue, weight loss, weakness, fever, arthralgia, skin lesions, hypertension, renal insufficiency, neurologic dysfunction and abdominal pain.2 Despite the common involvement of the kidney, spontaneous perirenal hemorrhage from a renal vasculitic aneurysm is a rare complication. A 72-year-old man was admitted to the hospital with complaints of dyspnea and generalized edema that had persisted for 2 weeks. Physical examination revealed coarse and decreased breath sounds with moist rales. His serum potassium and creatinine level were 9.5 mEq/L and 10.6 mg/ dL, respectively. Viral makers and autoantibodies, including anti-neutrophil cytoplasmic antibodies, were negative. His erythrocyte sedimentation rate was 18 mm/h and high sensitive C-reactive protein was 21.4 mg/L. We performed emergency hemodialysis via femoral vein catheterization under the impression of acute kidney injury and uncontrollable potassium levels. After emergency dialysis, the patient’s condition slowly improved. On the 15th hospital day, he complained of a sudden onset of right flank pain accompanied by a hypotensive episode. Abdominal computed tomography showed massive perirenal hematoma around the right kidney (Panel A: arrow). Renal angiography showed multiple aneurysmal dilatations of the interlobar arteries of the right kidney, and we performed coil embolization (Panel B: arrows; Panel C). Polyarteritis nodosa was diagnosed according to the radiologic findings of aneurysmal dilatation of the interlobar arteries of the right kidney. Images in vascular medicine

Bilateral Ureteral Stones and Spontaneous Perirenal Hematoma in a Patient with Chronic Idiopathic Thrombocytopenic Purpura

Idiopathic thrombocytopenic purpura (ITP) is an immune thrombocytopenia with a usually benign clinical course. Bleedings are mostly of the mucocutaneous type with mild symptoms. Massive bleedings requiring transfusion are rarely seen, unless the number of platelets decreases to extremely low levels. In this case, bilateral perirenal hematoma and bilateral distal ureteral stones were detected on a non-contrast computed tomography scan of a 57-year-old male patient who developed macroscopic hematuria during his treatment in the clinics of internal medicine because of left flank pain and diffuse petechial rashes all over his body. The patient, who had been receiving chronic ITP treatment for 1 year, had a very low platelet count (4,000/mm3). The patient was prescribed bed rest, and his platelet count increased to a safe level for surgical intervention of above 50,000/mm3 with administration of prednisolone, intravenous immune globulin, and platelet suspension. A stone-free state was achieved after bilateral ureterorenoscopy and pneumatic lithotripsy. A conservative approach was followed for the perirenal hematoma. Upon regression of the perirenal hematoma, the patient was discharged at 9 weeks postoperatively.

Polyarteritis nodosa presenting with spontaneous perirenal hematoma

Spontaneous perirenal hematoma following ruptured microaneurysm is an unusual but serious complication of polyarteritis nodosa. We describe a young male who presented with spontaneous perirenal hematoma and was subsequently diagnosed to have polyarteritis nodosa. He was managed with immunosuppressive medications with no recurrence of symptoms.

Embolization of Bleeding Aneurysms in a Patient with Spontaneous Perirenal Hematoma Due to Polyarteritis Nodosa

Embolization of Bleeding Aneurysms in a Patient with Spontaneous Perirenal Hematoma Due to Polyarteritis Nodosa

Spontaneous perirenal hematoma due to Wegener’s granulomatosis after initiation of immunosuppressant

Spontaneous perirenal hematoma (SPH) is a rare, life-threatening condition. We present a patient with Wegener's granulomatosis (WG) who developed SPH soon after the initiation of immunosuppressant therapy. Few cases of SPH as a complication of WG have been reported, though a rupture of an aneurysm in patients with polyarteritis nodosa can lead to SPH. Though immunosuppressant therapy is considered to be the first-line therapy for SPH with vasculitis, SPH could still occur after the initiation of an adequate treatment regimen.

Polyarteritis Nodosa Presenting with Splenic Infarction, Bilateral Renal Infarction, and Hematoma

Polyarteritis nodosa (PAN) is a necrotizing vasculitis and may affect multiple organ systems. Due to the rupture of microaneurysms, perirenal hematomas may occur in both kidneys. Spontaneous perirenal hematoma is an infrequent complication of isolated PAN. Also, involvement of the splenic arteries is a rare occurrence in polyarteritis nodosa. Perirenal hematoma rupture is a serious clinical condition. Patients with life-threatening visceral bleeding must be treated with a selective embolization procedure or radical surgery because nonoperative management has been associated with a significant mortality rate.

Synovialosarcome primitif rénal : une tumeur kystique chez des patients jeunes

The study of the clinical, histological and immunohistochemical aspects of three kidney tumors corresponding to synovial sarcomas operated on in our center over three years. Three patients aged between 27 and 33 had an enlarged nephrectomy for kidney tumors corresponding to a histological examination of a synovial sarcoma. The tumors were symptomatic in 100% of cases with back pain and spontaneous rupture. Size varied from 5 to 13cm. The radiological aspect was a cystic tumor (BosniakIV) in two cases and in the other a spontaneous perirenal hematoma. Two were in the right kidney and one in the left kidney. The parts were analyzed after fixation. Immunohistochemical coloration and an analysis in molecular biology by RT-PCR of fusion transcripts were carried out. One patient died because of local development and metastasis 24 months after an enlarged nephrectomy associated with radio chemotherapy (Maidprotocol). Two patients were in total remission after an average of 25 months following the same treatment. The histology found a mesenchymal fusocellular monotone proliferation corresponding to a sarcoma. In all three cases, it was a biphasic form with plaques of fusiform cells and epithelial cells. The immunohistochemical study shows a positivity of the contingent epithelial and fusiform. The muscular markers were negative. A study in molecular biology of the fusion transcript allowed for the finding of a translocation (X;18) in all three cases. Primitive synovial sarcoma of the kidney occured in young patients. The translocation (X;18) is pathognomonic of the diagnosis. The prognosis is bleak despite complete excision, radiotherapy and chemotherapy.

Spontane perirenale Hämatome bei Patienten mit Koagulopathien oder unter Antikoagulanzientherapie

Spontaneous perirenal hematoma is a rare condition. The clinical features are acute flank or abdominal pain, haematuria, hypotension and shock. Bleeding is most commonly caused by renal tumours, especially angiomyolipomas. Other known causes are long-term haemodialysis, arteriosclerosis or arteritis. A total of 6 patients with spontaneous perirenal haemorrhage have been treated in our hospital since 2003. Nearly all patients had been taking anticoagulation medication. One had a bleeding diathesis. One of the patients died immediately after admission at the hospital. All other patients had an exploratory laparotomy. In three cases total nephrectomy had to be performed, two other patients could be treated with partial nephrectomy. In patients with non-traumatic acute flank or abdominal pain it is important to determine whether the patient has been taking anticoagulation medication or suffers from bleeding diathesis because there is a high incidence of bleeding complications in these cases. If an emergent laparotomy is not necessary we recommend that these cases should be treated surgically after clinical stabilisation because tumours are the main reason for the haematomas and the patients have an urgent need for further anticoagulation therapy.

Spontaneous perirenal hematoma with AA amyloidosis in a hemodialysis patient after unilateral nephrectomy

Secondary amyloidosis presents with a variety of systemic symptoms or signs. Amyloid diseases can be associated with potentially life-threatening hemorrhage. Although bleeding manifestations are common in amyloidosis, renal bleeding is rare and generally due to trauma, cyst and malignancy. For the first time we present a ureamic patient who was diagnosed with AA amyloidosis after unilateral nephrectomy because of spontaneous perirenal hematoma.

Spontaneous Perirenal Hematoma: A Case Report

Spontaneous perirenal hematoma is relatively uncommon but may be life threatening. There are some challenges in early diagnosis due to the lack of specific presentations. We report a case of spontaneous perirenal hematoma in a patient who had histories of systemic lupus erythematosus, hypertension, and uremia with hemodialysis, and initially presented with non-specific flank pain. Dizziness and unstable vital signs were noted in the emergency room. Computed tomography and abdominal ultrasonography revealed a large perirenal hematoma over the left retroperitoneal cavity. The patient received conservative treatment without surgical intervention and had an uneventful recovery.

Antiplatelet therapy and spontaneous perirenal hematoma

This case report clarifies an adverse reaction of antiplatelet therapy which has been a standard prophylactic method for patients harboring significant risks of thromboembolic events. A 71-year-old Japanese man who had been taking aspirin tablets (81 mg) for a year presented with sudden colic pain in the left flank region. An abdominal computed tomography scan revealed a significant perirenal hematoma of the left kidney. There were no pathological kidney conditions, such as renal tumors, calculi or vascular diseases, found by magnetic resonance imaging examination. After cessation of aspirin administration followed by conservative management, the hematoma completely disappeared 6 months later. This is the first documented case of spontaneous perirenal hematoma secondary to low-dose aspirin treatment. While such unpleasant events occur extraordinarily, this should be noted as a severe risk of antiplatelet therapy.

Etiology Of Spontaneous Perirenal Hemorrhage: A Meta-Analysis

Etiology Of Spontaneous Perirenal Hemorrhage: A Meta-Analysis

SPONTANEOUS SUBCAPSULAR RENAL HEMATOMA SECONDARY TO ANTICOAGULANT THERAPY

No AccessJournal of UrologyCLINICAL UROLOGY: Case Reports1 Apr 2001SPONTANEOUS SUBCAPSULAR RENAL HEMATOMA SECONDARY TO ANTICOAGULANT THERAPY NICOLA J. MABJEESH and HAIM MATZKIN NICOLA J. MABJEESHNICOLA J. MABJEESH More articles by this author and HAIM MATZKINHAIM MATZKIN More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)66472-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "SPONTANEOUS SUBCAPSULAR RENAL HEMATOMA SECONDARY TO ANTICOAGULANT THERAPY." The Journal of Urology, 165(4), p. 1201 References 1 : Clinical significance of gross hematuria and its evaluation in patients receiving anticoagulant and aspirin treatment. Urology2000; 55: 22. Google Scholar 2 : Spontaneous retroperitoneal hemorrhage from kidney causes. Eur Urol1988; 15: 281. Google Scholar 3 : Conservative management of non-traumatic subcapsular renal hematoma: a case report. Int J Urol1994; 1: 181. Google Scholar From the Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel© 2001 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 165Issue 4April 2001Page: 1201 Advertisement Copyright & Permissions© 2001 by American Urological Association, Inc.KeywordskidneyanticoagulantshematomaMetricsAuthor Information NICOLA J. MABJEESH More articles by this author HAIM MATZKIN More articles by this author Expand All Advertisement PDF downloadLoading ...

Hématome périrénal spontané bilatéral: une complication rare de la panartérite noueuse

Spontaneous perirenal hematoma is a serious and unusual complication of polyarteritis nodosa. Its treatment is not standardized. A review of the literature shows that therapeutic arterial embolization is an alternative to nephrectomy. We report a new case of spontaneous bilateral perirenal hematoma due to a rupture of a renal aneurysm in a 68-year-old patient presenting with polyarteritis nodosa. The patient had no hypertension. Renal arteriography helped guide the diagnosis, and selective embolization was performed to treat the left hematoma. The right hematoma only required symptomatic treatment. Arteriography with selective embolization appears to be a good alternative to nephrectomy in spontaneous perirenal hematoma complicating polyarteritis nodosa. However, in this case, the right hematoma required neither arteriography nor nephrectomy. This raises the questions of the necessity of selective embolization when the clinical status remains satisfying with a symptomatic treatment.