Presentation
Day two following fall from standing height. On warfarin for AF.
Patient Data
Large left perinephric hematoma with compression/deformity of the left renal parenchyma. Contrast extravasation is demonstrated, suggestive of active bleeding. Extensive inflammatorystranding and hematoma is demonstrated in the left peri- and para-renal spaces. Blood density is seen in the pelvic intraperitoneal space. Extensive presacral edema also present.
The liver has an unremarkable appearance. Hyperdense material is demonstrated layering in the neck of the gallbladder. No intrahepatic duct dilatation is seen. The pancreas demonstrates fatty replacement consistent with the patient's age. ELS abdominal aortic aneurysm. Calcific splenic granuloma. Previous left total hip replacement and aortoiliac graft is demonstrated.
1.9cm exophytic lesion arising from the posterior aspect of the right renal midpole has suspicious thick peripheral enhancement--renal cell carcinoma requires exclusion. Smaller simple cyst laterally.
Previous coronary artery bypass surgery noted. Heavy vascular calcification diffusely. Small bilateral pleural effusions and passive atelectasis is noted.