Spontaneous Perirenal Hemorrhage Research Articles

Management Outcomes of Large Renal Angiomyolipoma Presenting with Wunderlich Syndrome-Experience from a Tertiary Center.

Renal angiomyolipoma is an uncommon, benign-mixed mesenchymal tumor consisting of thick-walled blood vessels, smooth muscles, and mature adipose tissues. Twenty percent of these tumors are associated with tuberous sclerosis. Wunderlich syndrome (WS), an acute nontraumatic spontaneous perirenal hemorrhage, can be a presentation of large angiomyolipoma. This study evaluated the presentation, management, and complications of renal angiomyolipoma with WS in eight patients who presented to the emergency department between January 2019 and December 2021. The presenting symptoms included flank pain, palpable mass, hematuria, and bleeding in the perinephric space on computerized tomography. Demographic data, symptoms at presentation, comorbidities, hemodynamic parameters, the association with tuberous sclerosis, transfusion requirements, need for angioembolization, surgical management, Clavien-Dindo complication, duration of hospital stay, and 30-day readmission rates were evaluated. The mean age of presentation was 38 years. Of the eight patients, five (62.5%) were females and 3(37.5%) were males. Two (25%) patients had tuberous sclerosis with angiomyolipoma, and three (37.5%) patients presented with hypotension. The mean packed cell transfusion was three units, and the mean tumor size was 7.85 cm (3.5-25 cm). Three of them (37.5%) required emergency angioembolization to prevent exsanguination. Embolization was unsuccessful in one patient (33%) who underwent emergency open partial nephrectomy, and one (33%) patient developed post-embolization syndrome. A total of six patients underwent elective surgery-four underwent partial nephrectomy (laparoscopic - 1, robotic - 1, open - 2) and two underwent open nephrectomy. Three patients encountered Clavien-Dindo complications (Grade 1, n = 2 and IIIA, n = 2). WS is a rare, life-threatening complication in patients with large angiomyolipoma. Judicious optimization, angioembolization, and prompt surgical intervention will help deliver better outcomes.

Spontaneous perirenal hemorrhage in a pregnant woman due to the rupture of a simple renal cyst

Renal cysts are diagnosed by ultrasonography, computerized tomography (CT), or urography. A 36-year-old pregnant woman (G2, Ab1, within the gestational age of 38 weeks) with upper abdominal pain starting from two hours ago, vomiting, and nausea was referred to the emergency department. Although abdominal examinations revealed costovertebral angle tenderness, there were no signs of peritoneal irritation, and all vital signs of the patient were in a normal range. Initial investigation results including blood count (Hb: 11.4), BUN/Cr, Na/K, and UA were normal. She underwent a cesarean section (c/s) due to reduced fetal heart rate (FHR). After C/S,the CT scan showed a large left retroperitoneal hematoma with an anterosuperior displacement of the kidney and active bleeding in the cystic lesion of the upper pole of the kidney. Pathological examinations also confirmed a simple cyst. Overall, simple renal cysts should be considered as a rare cause of spontaneous perinatal hemorrhage (SPH) in pregnancy. The diagnosis and treatment of SPH in pregnancy are also critical challenges.

A CASE OF HEMMORRHAGIC SHOCK CAUSED BY WÜNDERLICH SYNDROME

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Wünderlich syndrome (WS) is a rare condition caused by acute renal hemorrhage and characterized by flank pain, flank mass and hypovolemic shock. We report a complex case of WS in an elderly gentleman with left flank pain and nausea. CASE PRESENTATION: An 81-year-old man with diabetes mellitus type 2, end-stage renal disease on hemodialysis, chronic atrial fibrillation on apixaban and coronary artery disease with history of percutaneous coronary intervention on clopidogrel who presented to a tertiary care center with acute onset left flank pain and nausea for six hours. Upon arrival, the patient was found to have a blood pressure of 78/54 mmHg and a ventricular paced rhythm at 70 bpm. His physical examination was significant for tenderness to palpation over the left flank, as well as a palpable flank mass. His hemoglobin at presentation was 12.1 gm/dL but a repeat value resulted 6.6 gm/dL. Computed tomography (CT) of the abdomen and pelvis revealed multiple renal cysts and a 25 x 11 cm hemorrhagic left kidney concerning for a ruptured cyst with extravasation of blood extending to the retroperitoneum along the psoas muscle. The patient was emergently transfused packed red blood cells, four-factor prothrombin complex concentrate and fresh frozen plasma to reverse the effect of his chronic anticoagulation and antiplatelet therapy. A multidisciplinary decision was reached that an urgent nephrectomy would be associated with a prohibitively high perioperative risk, as releasing the hematoma into the retroperitoneum may result in a complex, uncontrollable hemorrhage. The patient subsequently underwent a renal arteriogram and interventional radiology-guided selective embolization of left inferior pole artery. Repeat CT with contrast showed a stable left renal, perinephric and retroperitoneal hematoma. The patient recovered from hypovolemic shock and was successfully weaned off vasopressor support. DISCUSSION: Wünderlich syndrome is a potentially life-threatening condition that requires prompt recognition and management. The most common etiologies are malignant neoplasms (61%) followed by angiomyolipomas (29.1%). Hemorrhagic ruptured cysts are a rare cause of WS, and rupture into the perinephric space is among the rarest presentations. Emergent angioembolization may be effective. Follow-up often includes exploratory laparotomy or laparoscopy. However, if malignancy is not clearly identified on CT imaging, conservative management with repeat imaging is a reasonable alternative. CONCLUSIONS: Although rare, Wünderlich syndrome is a rapidly progressing condition with high mortality that requires time-sensitive diagnosis and emergent management. REFERENCE #1: 1. G Albi, L del Campo, D Tagarro, Wünderlich's Syndrome: Causes, Diagnosis and Radiological Management, Clinical Radiology, Volume 57, Issue 9, 2002, Pages 840-845, ISSN 0009-9260, https://doi.org/10.1053/crad.2002.0981 REFERENCE #2: Zhang JQ, Fielding JR, Zou KH. Etiology of spontaneous perirenal hemorrhage: a meta-analysis. J Urol. 2002;167(4):1593-1596. doi:10.1097/00005392-200204000-00006 REFERENCE #3: Medda M, Picozzi SC, Bozzini G, Carmignani L. Wunderlich's syndrome and hemorrhagic shock. J Emerg Trauma Shock. 2009;2(3):203-205. doi:10.4103/0974-2700.55346 DISCLOSURES: No relevant relationships by Ana de Diego Diaz, source=Web Response No relevant relationships by Jeany Villamizar, source=Web Response No relevant relationships by Ann Vu, source=Web Response

Spontaneous perirenal hemorrhage in systemic lupus erythematosus: a rare case report and literature review

BackgroundSpontaneous perirenal hemorrhage is relatively uncommon but may be life-threatening. There are some challenges in early diagnosis due to the lack of specific presentations.Case presentationWe report a case of spontaneous perirenal hemorrhage in a newly diagnosed systemic lupus erythematosus patient who initially presented with non-specific flank pain. Weakness and unstable vital signs were noted on admission. Abdominal ultrasonography and computed tomography revealed a sizable perirenal hematoma over the left retroperitoneal cavity. Renal arteriography identified active extravasation of contrast media from a distant branch of the left renal artery, and selective embolization effectively obliterated the bleeding spot. After cessation of bleeding, the patient received intensive immunosuppressive therapy for acute kidney injury and encephalopathy due to lupus. Her mental status recovered successfully, and she was withdrawn from short-term hemodialysis.ConclusionsSpontaneous perirenal hemorrhage in the condition of systemic lupus erythematosus was a rare clinical entity with life-threatening potential. Early accurate diagnosis of spontaneous renal hemorrhage requires both detailed clinical examination and radiologic studies. Interventional embolization is essential and effective for both diagnosis and treatment. A high index of suspicion is necessary to avoid missing this potentially fatal syndrome, especially in patients with an increased risk of bleeding.

A rare case of spontaneous perirenal hemorrhage - Wunderlich syndrome

Introduction. Spontaneous perirenal hemorrhage or Wunderlich syndrome represents a rare entity in urological settings. The vast majority of the causes are represented by angiomyolipoma and renal cell carcinoma. In other cases, vascular abnormalities, polycystic kidneys, polyarthritis nodosa, or pyelonephritis could represent the cause of perirenal bleeding. The treatment depends on the clinical parameters at the presentation as well as on the possible presence of renal malignancies. Our goal was to present a rare case of a healthy men who presented the idiopathic Wunderlich syndrome. Case outline. We present a case of a 50-year-old patient with spontaneous perirenal hemorrhage that was not due to any defined cause even after a six-months follow-up. Conclusion. In some rare cases of perirenal bleeding, the cause cannot be defined at the presentation, even with today?s advanced radiological imaging methods. Thus, it is important to be aware of the fact that in those cases, a longer follow-up is needed, knowing that the presence of perirenal hematoma can always obscure the real diagnosis. Sometimes, even in cases where the proper follow-up has been done, the real cause of the bleeding remains unknown.

Spontaneous perirenal hemorrhage in a patient on an anticoagulant for stroke with severe aortic valve stenosis: Is concern for renal malignancy

Spontaneous perirenal hemorrhage is mainly due to renal malignancy. But its presence in a patient who are on anticoagulant make it challenging for the diagnosis. We report a case of 50-year-old man who presented with brain stroke and started on an anticoagulant. Post anticoagulant treatment he presented with flank fullness. On evaluation, he found to have right perirenal hematoma suspicious of renal malignancy and severely stenosed aortic valve. We did right nephrectomy and aortic valve replacement simultaneous and on histopathologically found to have papillary renal cell carcinoma.

A preliminary study on classification and therapeutic strategies for spontaneous perirenal hemorrhage

BackgroundThe aim of our study was to report our experience in the classification and therapeutic management strategies for spontaneous perirenal hemorrhage (SPH). MethodsFrom September 2005 to April 2015, 20 patients with SPH were newly diagnosed in our hospital. Their clinical features, image findings, identification of underlying causes, and therapeutic management were retrospectively analyzed, and relevant literature was reviewed. In this study, patients were classified according to the degree of severity of the disease or emergency imaging diagnosis of underlying causes. On the basis of the former, patients were classified as critical and noncritical, and on the basis of the latter, patients were classified as renal cell carcinoma (RCC), undefined solid neoplasm, angioleiomyolipoma (AML), and unknown cause. ResultsIn the acute stage, contrast-enhanced computed tomography (CT) was superior to ultrasonography for both diagnostic accuracy of SPH (p = 0.02) and etiology discovery power (p = 0.004). The results of contrast-enhanced magnetic resonance imaging (MRI) were identical to those of contrast-enhanced CT. We summarized a flowchart in the whole classification and therapeutic strategies of SPH. According to the imaging diagnosis of underlying causes, all the patients with undefined solid neoplasm or RCC underwent emergency operation. Patients with AML or unknown cause underwent selective arterial embolization (SAE) or conservative management according to the critical degree. Acute hemorrhage was controlled in 19 cases, of which 14 were cured by the operation and only one critical patient with severe shock died shortly despite rescue efforts. ConclusionsContrast-enhanced CT or MRI is the first choice of imaging examination, which could not only accurately diagnose SPH but also detect the underlying causes. Choice of therapeutic strategies for SPH should vary according to the identification of critical patients and imaging diagnosis of underlying cause.

Spontaneous perirenal hemorrhage (Wunderlich syndrome): An analysis of 28 cases

IntroductionThis study aimed to analyze the characteristics, etiology, and treatment of a series of patients with spontaneous perirenal hemorrhage (Wunderlich syndrome [WS]). MethodsWe retrospectively reviewed the records of 26 patients hospitalized for WS in a tertiary urological center between 2011 and 2018. All patients were evaluated for perirenal hemorrhage observed on computed tomography (CT) in the emergency department. Clinical variables (age, underlying diseases, symptoms, shock, and hospitalization period), laboratory test results, and radiological and pathological results were reviewed. ResultsThe series included 28 events from 26 patients with a mean follow-up period of 20.2 ± 18.0 months. Flank pain was most common symptoms (92%). Twelve patients (46%) had visible renal lesions and associated hematoma and 14 only showed perirenal hematoma. In six patients with shock (systolic blood pressure < 90 mm Hg), 2 underwent emergency angioembolization. Twelve patients (46%) underwent exploration and total nephrectomy. In the final diagnosis, 4 cases of renal cell carcinoma, 3 of angiomyolipoma, 4 of simple renal cyst, 2 of acquired cystic kidney disease, 4 of sarcoma or other malignancy, 4 of chronic pyelonephritis, and 5 of idiopathic WS were observed. Patient age was associated with prediction of renal cell carcinoma in the patients with WS. ConclusionRenal masses are the main cause of WS, and CT is the diagnostic procedure of choice. Old age is a possible risk factor for renal cell carcinoma in etiology of WS. Surgical treatment is preferred in patients diagnosed with renal malignancy and in cases of hemodynamic instability.

Wunderlich syndrome as the first manifestation of an extraskeletal Ewing sarcoma.

We recently encountered an extremely rare case of spontaneous perirenal hemorrhage in a 34-year-old man. He initially had undergone radical nephrectomy owing to suspicion of renal cell carcinoma. The final diagnosis was extraskeletal Ewing sarcoma.

Bilateral Spontaneous Perirenal Hemorrhage due to Initial Presentation of Polyarteritis Nodosa

Spontaneous perirenal hemorrhage (SPH) is uncommon but can be a life-threatening condition which is associated with flank or abdominal pain and hypovolemia. The etiologies of SPH include tumor, vascular disease, and infection. Among the vascular diseases, polyarteritis nodosa (PAN) is common cause of the SPH. However, patients with PAN usually complain of nonspecific symptoms and the incidence of PAN is relatively rare. So, diagnosis is difficult even though tissue biopsy and angiography help to confirm the PAN. Particularly bilateral perirenal hemorrhage is very rare complication in patients with PAN. We reported a case of bilateral perirenal hemorrhage in the patients with PAN who have continued to take exogenous sex hormone.

Spontaneous bilateral perirenal hemorrhage following prolonged fever: an uncommon presentation of polyarteritis nodosa

A 68-year-old man presented with a spontaneous bilateral perirenal hemorrhage following a 2-month fever of unknown origin. A renal biopsy for a pathologic diagnosis seemed very risky because of the patient's bilateral perirenal hemorrhage. Therefore, we diagnosed polyarteritis nodosa using an abdominal computed tomography scan, a renal angiogram, and American College of Rheumatology criteria. The patient's multiple symptoms then responded well to the prescribed immunosuppressive regimen. This case is an uncommon presentation of polyarteritis nodosa with fever of unknown origin before a spontaneous bilateral perirenal hemorrhage.

Spontaneous Perirenal Hemorrhage from Renal Capsular Artery in Cauda Equina Syndrome: A Case Report

PM&RVolume 5, Issue 9S p. S271-S271 Neurological Rehabilitation Spontaneous Perirenal Hemorrhage from Renal Capsular Artery in Cauda Equina Syndrome: A Case Report Hyun Seok MD, PhD, Hyun Seok MD, PhD Soonchunhyang University Bucheon Hospital, Bucheon, Republic of KoreaSearch for more papers by this author Hyun Seok MD, PhD, Hyun Seok MD, PhD Soonchunhyang University Bucheon Hospital, Bucheon, Republic of KoreaSearch for more papers by this author First published: 17 September 2013 https://doi.org/10.1016/j.pmrj.2013.08.467Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume5, Issue9SSeptember 2013Pages S271-S271 RelatedInformation

Flank Pain, Nausea, Vomiting and Hypotension in a Chronic Hemodialysis Patient with a Spontaneous Perirenal Hemorrhage

Decreases in blood pressure develop in response to a wide range of clinical disorders. Various factors have been implicated in the development of hemodialysis-associated hypotension, including an impairment of the compensatory processes, an autonomic dysfunction or cardiac failure. The additional presence of concomitant acute abdomen may result in a diagnostically challenging situation. We herein report our experience with a chronic hemodialysis patient who developed severe hypotension with acute flank pain due to spontaneous bleeding around the kidney. Concerns regarding the management of the disease are also discussed.

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.

Perirenal hemorrhage: rare complication of warfarin coagulopathy

Keywords Chronic kidney disease Perirenalhemorrhage Warfarin Wunderlich syndromeA 68-year-old man with advanced diabetic nephropathywas transferred to our hospital for arteriovenous fistulacreation. One month before admission, he had startedanticoagulation therapy with warfarin potassium andreceived permanent IVH filter placement for deep venousthrombosis. On the fifth day of admission, macrohematuriaand acute bilateral flank pain developed. Laboratory testsdisclosed a sudden increase in the serum creatinine con-centration (from 7.0 to 9.1 mg/dl), progression of anemia(from 9.4 to 7.7 g/dl), and markedly elongated PT-INR(6.79). Unenhanced CT revealed low- to middle-attenua-tion fluid collection in subcapsular and perirenal retro-peritoneal spaces (Fig. 1). There was no history oftraumatic injury. Spontaneous perirenal hemorrhage wasdiagnosed. He was kept at absolute rest and vitamin K2was administered intravenously. Follow-up CT showedsubstantial improvement of the hemorrhagic lesion(Fig. 2), and no suspicious underlying etiology wasdetected.Spontaneous renal hemorrhage into the perirenal retro-peritoneal spaces is called Wunderlich syndrome [1].Underlying etiologies include benign and malignantneoplasms, rupture of fragile cysts, vascular disease, andcoagulation disorders. In cases with uncontrollable bleed-ing, partial or complete nephrectomy is necessary. Mark-edly elongated PT-INR due to warfarin potassium is aplausible cause of the bilateral perirenal hemorrhage in thepresent case. Recently, a relationship between acutelyincreased PT-INR and exacerbation of renal dysfunctionwas reported [2, 3]. In addition to hematuria and acuterenal dysfunction, perirenal hemorrhage should also beconsidered in patients receiving anticoagulation therapy.

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 Spontaneous Perirenal Hemorrhage in an Acquired Cystic Kidney Disease Hemodialysis Patient

Acquired cystic kidney disease (ACKD) is a well-known late stage complication of chronic kidney disease. Cysts tend to grow with time on dialysis and could lead to malignant transformation, and intra- or perirenal hemorrhage is a rare complication of ACKD. Here we describe one case of bilateral spontaneous perirenal hemorrhage of ACKD in a 44-year-old man, on hemodialysis for 15 years. One was due to cyst rupture, and the other was due to aneurism rupture, both were controlled with transcatheter arterial embolization. In renal arteriography at the second rupture, we demonstrated extravasation from an aneurysm being present at the periphery of right renal artery. Several spontaneous perirenal hemorrhage cases were reported but its clinical information is limited, moreover, bilateral cases were extremely rare. Furthermore, to our knowledge, this is the first report of spontaneous perirenal hemorrhage caused by intraparenchymal renal artery aneurysm rupture in ACKD patients. We report this case because of its rarity and significance with respect to the complication of dialysis patients, review reported bilateral cases, and discuss some clinical characteristics.

Spontaneous perirenal hemorrhage: what radiologists need to know

Spontaneous perirenal hemorrhage (SPH), also known as Wünderlich's syndrome, is a rare urological emergency. This article reviews the most common causes of SPH and the role of imaging in establishing the correct diagnosis and in guiding the appropriate therapy. A thorough understanding of underlying etiologies, imaging appearances, optimal imaging techniques, and follow-up protocols are crucial to recognize patients with SPH due to benign disease and avoid unnecessary nephrectomies.

A case of familial Mediterranean fever and polyarteritis nodosa complicated by spontaneous perirenal and subcapsular hepatic hemorrhage requiring multiple arterial embolizations

The association of familial Mediterranean fever (FMF) and polyarteritis nodosa (PAN) has been well established. These patients have been reported to have an overall better prognosis than other PAN patients. Herein we report a patient with FMF and PAN who died of sepsis following a severe course of recurrent bleeding episodes which required multiple embolization attempts. The 39-year-old Turkish male presented with abdominal pain of 1-month duration. He had been diagnosed with FMF at the age of 24. On admission, he had pallor with general ill appearance. Rebound tenderness was obtained in the right upper abdominal quadrant. He had mild anemia, leukocytosis, thrombocytosis, and hypoalbuminemia. On the 2nd day of his admission, he developed hypotension with a rapid decline in hemoglobin level. Abdominal angiography showed multiple aneurysms in the branches of renal arteries, superior mesenteric artery, and hepatic arterial system including left renal infarct, suggesting PAN. He was put on high-dose steroids and oral cyclophosphamide. Despite medical treatment, he developed intense abdominal pain, hypotension, tachycardia, and a rapid fall in hemoglobin on four occasions. Active bleeding sites were embolized in two different angiography sessions. Although the patient experienced no more recurrent bleeding, he died of multiorgan dysfunction syndrome resulting from sepsis 6 weeks after admission. Polyarteritis nodosa associated with FMF may follow a grave course despite immunosuppressive therapy. Arterial embolization should be considered in the presence of bleeding aneurysms in addition to immunosuppressive therapy.

Spontaneous perirenal hemorrhage: a 10-year experience at our institution.

To report our experience in patients with spontaneous perirenal hemorrhage (SPH) seen at our institution over a 10-year period. Over the years from 1992 to 2002, 13 patients with SPH without a history of trauma, were treated at our hospital. There were 5 male and 8 female patients with a mean age of 55.7 years (range 36-79 years). The patients' records were reviewed retrospectively with respect to etiology, clinical presentation, radiologic findings and therapeutic management of SPH. All patients were presented with flank or abdominal pain. Radiological evaluation included ultrasonography (U/S) in 7 cases and computed tomography (CT) in 13 cases. An underlying renal mass was indentified employing U/S in 2 cases and using CT in 10 cases respectively. The etiology of SPH was determined in 12 cases. The most common causes were angiomyolipoma (5 patients) and renal cell carcinoma (4 patients). Out of the remaining 4 cases with SPH, one was associated with anticoagulant therapy; polyarteritis nodosa and Wegener angeitis were the underlying diseases in 2 cases respectively; finally, the etiology could not be determined in 1 case. All but two patients were managed surgically. Complete nephrectomy was performed in 6 cases, partial nephrectomy in 4 and simple evacuation of the haematoma was performed in 1 case. SPH presence should arouse suspicions concerning its etiology, since the most common cause is a renal tumor and approximately 50% of such tumors are malignant. CT scanning is a useful imaging modality for the initial evaluation of SPH, permitting identification of the underlying cause in most instances.