Perirenal haematoma (post biopsy)
History of right pelvic resection, now with thrombocytopaenia and acute kidney injury. The patient had a non-targeted left renal biopsy. Increasing flank pain and abdominal distention prompted a CT scan.
2 case question available
CT abdomen and pelvis - noncontrast
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There is a large haematoma in the left perirenal space, extending into the anterior and posterior pararenal spaces, as well as a small amount extending into the intraperitoneal space. The left kidney is displaced anteriorly.
The higher attenuation material represent more acute blood products. There is no discrete sentinel clot.
There is also a large rounded filling defect in the pelvis, compatible with a large clot in the bladder.
3 case question available
Haemorrhage and haematoma are a risk in percutaneous renal biopsy, even if the patient has no specific risk factors. Small haematomas are common (~90% in one series), but large haematomas are uncommon.
Blood products in the abdomen start at blood pool attenuation. Then, as they age and the haemoglobin concentrates, the haematoma increases in attenuation (up to 60-80 HU). As the haematoma ages and becomes a seroma, the attenuation drops back to around 30 HU.
If the cause of a renal/perirenal haematoma is known (such as biopsy), then further imaging is not necessary unless the patient is not clinically improving and there is concern for an expanding haematoma. If the patient does not have a reason for the haematoma, then one should be concerned about an underlying mass that is haemorrhaging. The patient should return after resolution of the haemorrhage to assess for an underlying mass with contrast enhanced CT or MRI.
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