Splenic and pancreatic injury following renal biopsy

Case contributed by Dr James Harvey

Presentation

Biopsy performed by renal team for investigation of declining renal function. The patient subsequently experienced severe left upper quadrant pain.

Patient Data

Age: 70 years
Gender: Male

CT was performed 12 hours following the biopsy:

  • There is a mixed-density crescentic collection indenting the lateral margin of the spleen, in keeping with a subcapsular hematoma.
  • A hypodense tract can be seen extending through the spleen.
  • On the arterial phase study, a tiny blush is evident within the posterior spleen, without expansion on the portal venous phase CT.
  • Fluid is present within the anterior pararenal space and there is fatty stranding surrounding the pancreatic tail.
  • Moderate volume high-density fluid (blood) within the pelvis and left paracolic gutter.
  • Background hepatic steatosis. Small left pleural effusion.

The patient's serum lipase was elevated.

DSA (angiography)

The patient's hemoglobin continued to reduce over the next 48hrs. He was referred to interventional radiology and a splenic artery angiogram was performed.

Three small pseudoaneurysms were identified. Microcoils were placed across a segmental splenic artery with good angiographic result.

Case Discussion

Renal hematoma is the most common complication following renal biopsy. Non-renal injuries can rarely occur.

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Case information

rID: 72870
Published: 18th Jan 2020
Last edited: 14th Jul 2020
Inclusion in quiz mode: Included

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