Infected perinephric hematoma

Case contributed by Ian Bickle
Diagnosis almost certain


Known renal stone disease. Sudden onset left flank pain. Infection?

Patient Data

Age: 60 years
Gender: Female

2cm depth left perinephric hematoma (HU 60) with several small foci of gas within. Small amount of gas in the renal parenchyma. The left kidney is displaced anteromedially.  Perinephric stranding.

Bilateral nephrolithiasis.  No ureteric stone.  No hydronephrosis.

Small amount of blood in the pelvis.


Case Discussion

In this case, no given history of intervention pro-offered (Eg, PCNL, lithotripsy or attempted aspiration) to explain the hemorrhage and perinephric gas.

The gas in largely within the perinephric hematoma, not the renal parenchyma.   The HU is indicative of blood and an attempted aspiration also yielded a small volume of clotted blood.

Spontaneous perinephric hematomas may occur.  The gas relates to secondary infection.

Aspiration and subsequent culture grew Staphalococcus.


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