Presentation
Acute kidney injury, hypertensive urgency, and thrombotic thrombocytopenic purpura (TTP).
Patient Data
There is a heterogeneous and relatively high-density collection in the right retroperitoneum extending into the extraperitoneal pelvis. There is a small amount of intermediate-density fluid within the peritoneal space extending into the right lower quadrant and pelvis. Hemorrhage is difficult to quantify given its inconsistent density and shape but spans from approximately the upper pole of the right kidney to the iliac fossa and slightly tracks into the right groin.
Case Discussion
This case involves a patient with thrombotic thrombocytopenic purpura (TTP) syndrome who underwent a right-sided renal biopsy. The biopsy was technically challenging and the decision was made to abort the procedure. Additionally, the procedure was complicated by a right retroperitoneal hemorrhage which remained undetected until a complete blood count the following day showed a hemoglobin of 6.3. This CT was taken to investigate the source of the sudden drop in hemoglobin Fortunately, the bleeding stopped spontaneously, and the patient agreed to proceed with a left kidney biopsy a few days later. The left kidney biopsy was performed without complications.
This case underscores the need for careful patient selection and preparation, especially in patients with a bleeding diathesis. In complex biopsies, close monitoring and management of potential complications are crucial.
Co-author: Hashem Elessawy, DO
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