Active renal extravasation with large subcapsular and retroperitoneal hemorrhage
Citation, DOI, disclosures and case data
At the time the case was submitted for publication Michael P Hartung had no recorded disclosures.View Michael P Hartung's current disclosures
Sudden onset of severe left flank pain.
Loading Stack -
0 images remaining
Left renal active extravasation with massive subcapsular hemorrhage. Bleeding appears to originate from the left interpolar cortex. Blood products extend into and throughout the retroperitoneum. Mass effect and deformity of the kidney and abdominal organs.
Small area of hypodensity in the posterior gastric body which does not change on arterial and portal venous phase images, likely ingested material. Few areas of strandy enhancement along the leftward aspect of the gastroesophageal junction seen only on portal venous phase images, favoring a varix based on appearance on the coronal and sagittal reformats, less likely small venous bleed.
Subtle, nodular contour of the liver with a small number of perihepatic ascites. Trace pleural effusions with basilar atelectasis.
This patient was hemodynamically unstable, required multiple blood transfusions and pressors, and was immediately transferred to the angiographic suite and underwent embolization coiling of the left posterior branch of the renal artery (images unfortunately not available).
Renal hemorrhage can happen as a result of trauma, in the setting of vasculopathy (such as polyarteritis nodosa), or from a neoplasm (most commonly AML or RCC).
This patient was not anticoagulated. However, some degree of coagulopathy may be present given the subtle findings of cirrhosis and history of substance abuse (positive for cocaine and amphetamines). There was also report of possible falls.
Given the size of the hemorrhage, it would be appropriate to perform follow-up imaging to ensure no underlying mass. It would not be advisable to do further evaluation with MRI or ultrasound urgently, as most subtle findings would be obscured by the large amount of blood products, greatly limiting the sensitivity of these examinations. Additionally, a negative MRI or ultrasound at the time of presentation would not obviate the need for follow-up.
1 article features images from this case
31 public playlists include this case
- Abdo VIVA by Lucy Blumer
- extremely good cases by Vijaylaxmi .
- ICU abdo by Duy Nguyen ◉
- Gut by Laylamfekry
- Day 5: Beginner's test by Michael P Hartung ◉
- genitourinary by Prabhat karki
- Abdo Cases by Ashlee Kates-Ascioti
- gu nov 2018 by Karina Dorfman
- abdomen key cases by Mini Singhal
- FRCR Companion UG 31 Jan by Laila Adel Mohsen
- GU by Naveed Ahmad ◉
- GIT by Sameh Saied Ali ◉
- Vascular, bleeding, or infarcts by Michael P Hartung ◉
- FRCR 2B 3 by Sherif Mohsen
- GUT by Maimoona murad khan
- RADIO EXAM 2 by edioardo bonamano
- Rae Abdo by Ruilin Raelene Jin ◈
- Acute abdomen by Daniel Eric Wingard
- IR2-P2 by tuanleminh ◉
- team 3 by Awadh Ahmed taiseir BA HASHWAN
- A rough night on call: abdominal CT in the ED by Michael P Hartung ◉
- Genitourinary by Michael P Hartung ◉
- VC PART II GIT GU by Vinicius Carraro do Nascimento
- Chest by Sameh Saied Ali ◉
- G! 2 by Kevin Sheng
- abdominal bleeding by Juana Ross
- MCA IM Resident Noon Conference - Sill 2023.01.17 by Andrew Sill
- SSAAA2 by Susheel K
- SRI 2 by Sridevi Shetty
- trauma by Susheel K
- A short 2021 by Abdullah Hajar