Perirenal hematoma with active extravasation after nephrostomy tube placement
Diagnosis certain
Presentation
Hospitalized due to left-sided ureteric occlusion caused by calculus, and resultant pyelonephritis. Percutaneous nephrostomy performed. Gradually decreasing blood pressure and hematocrit thereafter, large amount of perirenal fluid and drain migration suspected on POCUS. Active retroperitoneal bleeding?
Patient Data
Age: 80 years
Gender: Male
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- Large left-sided perirenal hematoma, with contrast blush indicating active extravasation
- Hypoenhancing left kidney, with negligible contrast excretion.
- Nephrostomy drain displaced, ending outside the kidney
- Simultaneous presence of extensive low density retroperitoneal collection is in line with urinoma
- Moderate hydronephrosis on the left, hydroureter, distal ureterolithiasis
- Other findings:
- subtle pleural effusion on the left
- kidney cysts
- known fusiform, partially thrombosed AAA affecting the right common iliac artery too
- small hiatus hernia
- normal excretion of contrast on the right with incidentally depicted contrast jet into the bladder
Case Discussion
Features of active iatrogenic retroperitoneal bleeding demonstrated post TRD placement. Thorough comparison of arterial and venous phase acquisitions pinpoints the site of active extravasation.
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