Spontaneous active bleeding into a cyst in autosomal dominant polycystic renal disease
Known ADPKD. Recurrent episodes of loin/flank pain. Now severe right loin/flank pain. No history of trauma.
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Typical polycystic disease involing kidneys and liver. Hyperdense right posterior renal cyst with contrast extravasation in the parenchymal phase (no collecting system contrast) into the cyst indicative of active bleeding at the time of scanning. This is an unusual finding.
Bleeding into the renal cysts of ADPKD is well recognized and a cause of recurrent flank pain. It occurs more commonly than in simple renal cysts. Bleeding usually settles spontaneously but occasionally can progress leading to cyst rupture and bleeding into the perirenal spaces and even hemoperitoneum. Demonstration of active bleeding may prompt more aggressive treatment such as catheter arterial embolization in order to avoid cyst rupture.