Spontaneous Subcapsular Hematoma Research Articles

Spontaneous Subcapsular Haematoma as a Complication of Acute Pyelonephritis: Imaging Findings

Spontaneous Subcapsular Haematoma as a Complication of Acute Pyelonephritis: Imaging Findings

Non-traumatic Subcapsular Hematoma of the Liver in a Patient under Rivaroxaban: A Rare Clinical Occurrence

Direct oral anticoagulants are used in the management and prophylaxis of venous thromboembolism (VTE) and other thrombotic diseases including non-valvular atrial fibrillation. The most serious complication of DOAC agents is bleeding, dominated by gastrointestinal hemorrhages, even if the bleeding risk is much rarer compared to VKA therapy. DOACs are sometimes linked to hepatotoxicity which can sometimes lead to severe hepatocellular insufficiency and also to non-hemorrhagic gastrointestinal disorders. We present a rare clinical entity of a spontaneous subcapsular hematoma of the liver in patient diagnosed with thrombosis of the right internal jugular vein treated with rivaroxaban, undergoing chemotherapy and hormonotherapy after surgery for breast cancer. The diagnosis was confirmed by imagery (abdominal CT scan) after clinical manifestation of an onset pain at the right hypochondrium of the abdomen. Conservative treatment was used in the patient with close follow up after hospital discharge.

Spontaneous subcapsular hepatic hematoma in pregnant patients.

Spontaneous subcapsular hepatic hematoma (SSHH) with or without previous history of preeclampsia and/or HELLP syndrome represents a very rare pathological condition in pregnancy and postpartum, (1/45,000-1/225,000 pregnancies). Its importance for the anesthesiologist lays in its association with high morbidity and mortality for the mother (60-86%, 39%) and newborn (42%). After a high clinical suspicion, the certainty clinical diagnosis is settled by different imaging techniques. However, in most cases the diagnosis of SSHH is a casual intraoperative finding associated to a maternal or foetal compromise. Nowadays the obstetric and anaesthetic management of a SSHH is not standardized and depends on its integrity, hemodynamic stability and the gestational period when diagnosed. The possibility of an acute critic haemorrhage with necessity of massive transfusion, makes advisable to provide updated protocols for the treatment of obstetric hemorrhage, adapting them to the clinical peculiarities of these patients. After the acute phase, close attention should be kept on thromboembolic complications.

November 2022 Medical Image of the Month: COVID-19 Infection Presenting as Spontaneous Subcapsular Hematoma of the Kidney

No abstract available. Manuscript truncated after 150 words. A 57-year-old woman with pertinent medical history of hypertension presented to the emergency department with 3 days of right sided lower abdominal pain radiating to the flank, associated with nausea and nonbloody, nonbilious emesis. She reported recent travel to Florida where she visited amusement parks, but only rode small children’s rides with no experienced physical trauma. She experienced fatigue and chills 5 days prior to presentation and tested positive for SARS-CoV2 virus on admission. She had been vaccinated for COVID-19 x3 (Moderna). No other significant history nor medications were noted, and review of systems was otherwise unremarkable. Urinalysis demonstrated mild ketonuria (20), proteinuria (100) and moderate hematuria on urinalysis while BUN and creatinine remained stable at baseline throughout. Physical examination confirmed costovertebral angle tenderness to the right side. CT abdomen revealed an American Association for the Surgery of Trauma (AAST) grade 3 right renal subcapsular hematoma with 2.1 cm laceration …

Page kidney following spontaneous subcapsular hematoma immediately after kidney transplantation: a case report

BackgroundPage kidney (PK) is the occurrence of kidney hypoperfusion and ischemia due to pressure on the kidney by a subcapsular hematoma (SH), a mass, or fluid collection. SH after renal transplantation may result in kidney ischemia and graft loss.Case presentationWe present a rare case of early spontaneous SH in an allograft kidney that led to a decrease in renal function. A 56-year-old male patient underwent deceased donor kidney transplantation. After declamping, appropriate renal perfusion and immediate diuresis were observed, with no evidence of SH. However, his urinary output abruptly decreased 6 h postoperatively. Abdominal ultrasonography showed 28 mm deep SH on transplant and the resistive index (RI) increased to 0.98–1 and diastolic flow reversal was observed. Surgical interventions were performed 2 days after transplantation, following a further decrease in urinary output. Serum creatinine decreased to 2.2 mg/dL, urinary output increased to an average of 200 cc per hour and the RI value was decreased to 0.7 on POD 7.ConclusionIn patients with abrupt decreased renal function after transplantation, SH should be suspected and the presence of PK should be determined using Doppler USG. In these cases, surgical intervention may avoid allograft dysfunction.

S2733 A Curious Case of a Bleed Without a Cause

INTRODUCTION: Spontaneous subcapsular hematoma of the liver is usually associated with pregnancy, coagulopathy or liver lesion. We report a rare case of spontaneous subcapsular liver hematoma without any of the above risk factors. CASE DESCRIPTION/METHODS: A 59-year-old lady with a history of hypertension presented with sudden-onset in the right upper abdomen, right chest, shoulder and neck pain. She was otherwise hemodynamically stable other than being mildly hypertensive. Work-up for cardiac ischemia was negative. She was noted to have a low hemoglobin of 10.4 g/dl (prior baseline was 13.7 g/dL) and she had mild hepatocellular injury (ALT 32 IU/L, AST 31 IU/L). She underwent CT scan to rule out pulmonary embolism which incidentally revealed a large subcapsular liver hematoma. MRI abdomen confirmed a large lenticular shaped subscapular collection along the right lobe of the liver measuring approximately 12 × 4 × 16 cm. There was no focal hepatic lesion to explain the cause of bleeding. She did not recall any preceding trauma and there was no obvious trauma on exam. She was not taking any blood thinners. She admitted to inadvertently using oral contraceptives (OCP) for over 30 years for purely birth control purposes. The patient was admitted for observation and remained clinically stable over the next few days. At her 1-month follow-up, an office ultrasound showed that the size of the hematoma had decreased when compared to her prior ultrasound during her hospitalization (thickness from intercostal view decreased from 42 mm to 35 mm). At her 1-year follow-up, an MRI abdomen was repeated that showed a minimal residual hematoma and no discrete underlying lesion. DISCUSSION: Spontaneous subcapsular hematoma of the liver represents an accumulation of blood between the capsule of Glisson and the liver parenchyma, and is frequently located around the right lobe. If it ruptures into the peritoneum, it can be potentially fatal. Our case is unique in that none of the usual risk factors such as pregnancy, trauma, blood thinner use or underlying liver lesion were present. To our knowledge, there are very few similar case reports that describe spontaneous subcapsular hepatic hematoma. OCP use is generally associated with the development of hepatic adenoma, which can in turn cause spontaneous subcapsular hematoma. Theoretically, long-term OCP use in a post-menopausal hypertensive lady (such as in our case) may mimic the pathophysiology of pregnancy and independently lead to spontaneous subcapsular bleeding.Figure 1.: MRI showing large hepatic subcapsular hematoma and no focal lesion.Figure 2.: MRI showing nearly resolved hepatic subcapsular hematoma.

A case of rupture of voluminous spontaneous subcapsular hematoma of the liver in Bamako

Rupture of spontaneous subcapsular hematoma of the liver is very rare and therefore it has been rarely described in the literature. It generally occurs among women with underlying liver disease or often, during pregnancy, in women with HELLP syndrome. We here report the case of a 60-year old man with no particular past medical history presenting with large subcapsular haematoma of the liver. He was admitted to the Emergency Department with moderate-intensity right hypochondre pain evolving over the last week, which was aggravated, two days before, by influenza-like illness associating cough, yellowish sputum and sweatings. Clinical examination showed abdominal tenderness on palpation of the right hypochondre and hypogastrium. The remainder of the clinic examination was normal. Laboratory tests showed hemoglobin level 7.8g/dl, MCV: 79.9, reticulocyte count 48.9. computed tomography (CT) scan showed voluminous subcapsular hematoma of the liver measuring 17cm in height, 14cm in cross-sectional diameter and 5cm in thickness and a hepatic nodule measuring 10mm (A) with hemoperitoine of great abundance without active bleeding (B). The patient underwent visceral surgery (laparotomy) with favorable postoperative outcome.

Spontaneous Subcapsular Renal Haematoma in Adolescents: Report of Two Cases

Spontaneous Subcapsular Renal Haematoma in Adolescents: Report of Two Cases

Spontaneous Subcapsular Renal Hematoma as a Complication of Acute Pyelonephritis: A Case Report

Abstract Spontaneous subcapsular renal hematoma (SSRH) emerged as a complication of acute pyelonephritis (APN) is an extremely rare condition. We showed a patient aged 63 years hospitalized due to languor, febrility, abdominal pain accompanied by nausea and vomiting. Ultrasound (US) examination of the abdomen and multidetector computed tomography (MDCT) showed the presence of subcapsular hematoma of the left kidney with calculus in the initial part of the left ureter. Laboratory tests registered a positive inflammation syndrome, anemia and an increase in nitrogen compounds. Based on laboratory results, clinical presentation and imaging techniques it has been found that it is APN with spontaneous subcapsular hematoma. After application of non-surgical treatment which included antibiotic therapy with percutaneous drainage of hematoma, a good clinical response with regression of subjective symptoms and hematoma was obtained. On repeated US and MDCT after 18 months no pathological changes in the kidneys were registered. Spontaneous subcapsular hematoma extremely rare occurs as a result of APN associated with calculosis. The use of non-surgical treatment, which includes appropriate antibiotic therapy with percutaneous drainage of hematoma would represent a method of first choice.

Spontaneous Subcapsular Splenic Hematoma Associated with Filgrastim in a Patient Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

To report the development of a spontaneous subcapsular splenic hematoma following filgrastim administration in a patient undergoing an allogeneic hematopoietic stem cell transplant. A 60-year-old female with myelodysplastic syndrome was admitted for a reduced-intensity allogeneic hematopoietic stem cell transplant from an unrelated donor. She received filgrastim 5 μg/kg starting on day 1 to accelerate neutrophil recovery. On day 5, she began reporting severe left chest-wall pain. Contrast-enhanced computed tomography of the abdomen/pelvis revealed a spontaneous subcapsular splenic hematoma. Upon discontinuation of filgrastim, the pain fully resolved. The patient was subsequently rechallenged with filgrastim, which led to recurrence of the left-sided chest-wall pain. Filgrastim was discontinued and the patient reported resolution of the pain. Filgrastim has been associated with splenic hematoma and splenic rupture, predominantly in healthy donors undergoing mobilization of peripheral blood stem cells. Although splenic rupture attributed to filgrastim in a patient undergoing allogeneic hematopoietic stem cell transplantation has been reported, to our knowledge, this is the first case report to establish causality. Using the Naranjo probability scale, an objective causality assessment revealed that the adverse drug event was highly probable. Although filgrastim-induced splenomegaly, splenic hematomas, and splenic rupture are rare, clinicians working in the bone marrow transplant setting should be cognizant of the potential of growth factors to cause these adverse events.

An alarming but self-limited case of isolated large spontaneous liver hematoma in pregnancy

Spontaneous subcapsular liver hematoma is rare but potentially life-threatening complication of pregnancy usually associated with severe preeclampsia and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). We present here a case of such a large spontaneous liver hematoma presenting in pregnancy, but without other known associated abnormalities, which has not been described before and it resolved on itself without any intervention.

Late Spontaneous Subcapsular Hematoma in an Allograft Kidney

A spontaneous subcapsular hematoma in an allograft kidney is a rare condition with only a few cases reported in the literature. Common causes of subcapsular hematoma of an allograft include trauma, post-biopsy status, occult malignancy, vascular diseases, and infection. Chronic allograft dysfunction related to spontaneous subcapsular hematoma is extremely rare. We report a case of spontaneous subcapsular hematoma in a patient who underwent a renal transplant 14 years ago in which we could not find an associated condition.

Metastatic gestational trophoblastic tumour presenting as spontaneous subcapsular renal haematoma

We describe a rare case of metastatic choriocarcinoma, which presented with acute left loin pain due to a subcapsular haematoma secondary to a bleeding renal metastasis. The renal metastasis was embolised to prevent further bleeding. To our knowledge, presentation of gestational trophoblastic tumour (GTT) with such symptoms has not been described in the recent literature. Our case illustrates that, although rare, non-gynaecological symptoms can be the first presentation of metastatic choriocarcinoma in the appropriate clinical settings. It also demonstrates that the acute bleed from a renal metastasis can be effectively managed by embolisation.

Page kidney: successful radiological management of acute renal failure

Sir, Page kidney is the external compression of a kidney. The condition is usually caused by a subcapsular haematoma, associated with high blood pressure and occasional renal failure, as described by Irwin Page in an animal model with cellophane papers wrapped round the kidney in 1939 and, subsequently, clinically in 1955 [1,2]. The present case illustrates, in a patient with a single functioning kidney, the successful management of a spontaneous subcapsular haematoma that was causing both acute renal failure and hypertension. A 36-year-old female presented with a left-sided loin pain. At the age of 2 years she had undergone right nephrectomy for a Wilm’s tumour and left-sided lower lobectomy for pulmonary metastatic disease, followed by chemotherapy and radiotherapy. Six months before presentation, following her first pregnancy, she was diagnosed with dilated cardiomyopathy, for which she was given candesartan, carvedilol and warfarin. She was in pain, with tenderness over the left costovertebral angle. Her blood pressure was 94/57 mmHg. Investigation showed INR 2.7, C-reactive protein 20 mg/l and serum creatinine 136mmol/l. An ultrasound scan revealed a mixed reflective collection, adjacent to the postero-lateral aspect of her left kidney. Spectral Doppler analysis of the segmental arteries within the kidney showed a high-resistance pattern with complete loss of normal diastolic flow; but the renal vein was patent. A non-contrast computed tomography (CT) scan confirmed the finding of a subcapsular haematoma (Figure 1). In the following 48 h she became hypertensive, oliguric and her serum creatinine rose to 508mmol/l. Drainage was arranged. After reversal of anticoagulation, an 8F pigtail catheter was inserted percutaneously into the haematoma under ultrasound guidance and 100 ml sero-sanguineous fluid was drained. Ultrasound after 24 h showed a reduction in size

Spontaneous Subcapsular Splenic Hematoma: A Rare Complication of Pancreatitis

Subcapsular hematoma of the spleen is a rare complication of pancreatitis despite its close proximity to the pancreas. Pancreatic pseudocyst involving the tail of the pancreas may erode into the splenic hilum causing hilar vessel bleeding with subcapsular dissection and hematoma formation. The management of such complication is still controversial. It has been suggested that most of these complications spontaneously regress and therefore can be managed conservatively. A case of spontaneous splenic subcapsular hematoma resulting from pancreatitis was managed conservatively with a good outcome.

Percutaneous drainage of spontaneous subcapsular haematoma of the spleen complicating chronic pancreatitis

Subcapsular haematoma of the spleen is a rare complication of chronic pancreatitis. In the literature only a handful of cases have been documented. The exact aetiology and natural history of this complication remains speculative and its management controversial. A case of spontaneous subacute haematoma of the spleen in a patient with chronic relapsing alcohol-related pancreatitis was reported. A percutaneous drainage was performed with good outcome. A review of the literature has demonstrated only one previous similar report.

Spontaneous subcapsular liver hematoma associated with pregnancy.

Spontaneous subcapsular liver hematoma associated with pregnancy.

Hématomes spontanés sous-capsulaires du rein. À propos de 6 cas

Spontaneous subcapsular haematoma (SCH) of the kidney is a rare condition, secondary to kidney tumors in more than 50% of cases. Diagnosis is suggested by sonography and confirmed by CT-scan. Renal angiography, performed in haemodynamically stable patients, shows the origin of bleeding and allows embolization. The authors report 6 cases of SCH of the kidney, one of which occured after extra-corporeal shock-wave lithotripsy.

Etiology Of Spontaneous Perirenal Hemorrhage: A Meta-Analysis

Etiology Of Spontaneous Perirenal Hemorrhage: A Meta-Analysis

Spontaneous subcapsular renal haematoma

Spontaneous subcapsular renal haematoma is a rare condition caused by bleeding into the subcapsular or perinephric space in the absence of trauma, bleeding diathesis or anticoagulation. If the contralateral kidney is normal, radical nephrectomy is recommended due to a high incidence of small occult tumours.