Renal collecting system hematoma

Case contributed by Bálint Botz
Diagnosis certain

Presentation

Previous renal transplant recipient in the left iliac fossa. On the previous day a percutaneous nephrostomy tube was inserted due to newly developed hydronephrosis. Within less than 24 hours the drain stopped functioning.

Patient Data

Age: 40 years
Gender: Male
ultrasound

The calyceal system, the renal pelvis and the proximal ureter are dilated and filled with an inhomogenous clot. There is an about 6 mm thick hematoma in the perirenal space. The renal arterial resistive index is around the upper threshold of the normal range (0.7). The nephrostomic drain can not be identified in the collecting system. 

US B-mode cine loop

The pathology can be better appreciated in the cine loop.

ultrasound

The drain was removed, hematoma was managed conservatively, and completely cleared within four days as demonstrated by the control US above. However, the hydronephrosis persisted. 

Case Discussion

The case demonstrates self-limited perirenal and collecting system hematoma that occurred as a complication of the insertion of a nephrostomy tube. 

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