Renal hematoma

Fig. 24.22. Angiomyolipoma in a 15-year-old girl with tuberous sclerosis and acute abdominal pain related to tumor rupture. CT scan shows a vascularized intrarenal mass (arrows) containing fatty areas (arrowheads) and peri-renal hematoma (asterisk) (courtesy Prof. H. Ducou-Lepointe, Hopital A Trousseau, Paris, France)...

A 66-year-old woman developed Staphylococcus aureus septicemia 8 days after shoulder surgery. After the initial uneventful insertion of a catheter and injection of 30 ml of ropivacaine 0.5% for interscalene block she developed a small hematoma and required insertion of a new catheter after the first was dislodged on the second postoperative day. A continuous infusion of 0.2% ropivacaine 5 ml/hour was used for another 3 days, when the catheter was removed. After another 3 days she developed respiratory failure, acute renal failure, and disseminated intravascular coagulation. She was given intravenous antibiotics and made a prolonged recovery. 

Fig. 7.9. a CT of a 38-year-old female who had flank pain after a partial nephrectomy. A hematoma and a pseudoaneurysm (arrow) are seen, b Left renal arteriogram shows a pseudoaneurysm near the origin of the inferior branch of the renal artery, c Coils were placed distal and into the pseudoaneurysm, and an attempt was made to place the final coils just proximal to the pseudoaneurysm. These last coils moved out into the main renal artery occluding all renal artery flow, d An arteriogram done 3 months later shows some recanalization through the displaced coils with some perfusion to the kidney... 

Although rare, dissection or perforation of the renal arteries and their branches can occur. Rupture may lead to rapid development of retroperitoneal hemorrhage. Both dissection flaps and rupture can be immediately controlled with balloon tamponade. Although dissection flaps can often be tacked down, rupture typically requires emergent surgery. Even perforation of smaller branch vessels can occur if a guidewire is passed too far into the periphery. Hematoma and abscess can develop. 

Palvansalo M, Jarvy J, Sumaru I (1984) Occurrence of hematoma after renal biopsy - systemic follow up study by sonography. Clin Nephrol 21 302-303 Patriquin HB, O Regan S, Robitaille P et al (1989) Hemolytic-uremic syndrome intrarenal arterial Doppler patterns... 

Other lesions do not belong to this classification either. As stated above, intra-renal arteriovenous (or arterio-calyceal) fistulas or pseudo-aneurysms represent an excellent indication for super-selective angiography. Adrenal hematoma is frequently associated the diagnosis by CT is straightforward, the endocrine prognosis is usually excellent, and calcification is frequent on follow-up. 

Ultrasound is efficient to show perirenal collected fluid, hematoma or a mixture of urine and blood. A focal impression on the kidney is identified in subcapsular hematoma, while a collection with a ruptured capsula tends to surround and displace the whole kidney. Renal contusion can be identified as... 

Fig. 3.15a, b. Perigraft hematoma secondary to the rupture of a mycotic aneurysm, a Contrast-enhanced CT shows a dense collection (thick arrow) at the lower pole of the transplant surrounding the renal artery, b Gd-enhanced MR angiography shows the aneurysm close to the arterial anastomosis (thin arrow)... 

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