Presentation
Right loin pain and hematuria
Patient Data
A right renal complex cystic-like lesion with internal heterogeneous components is seen. It demonstrates mild internal vascularity on Doppler study. It was initially interpreted as Bosniak III cyst. The possibility of a hemorrhagic cyst is an important differential.
The right lower pole renal small well-defined rounded cortical lesion elicits complex density with areas of hyperdensity in the non-enhanced study. Minimal if any enhancement is noted in the post-contrast study.
The urinary bladder posteriorly demonstrates a wall endophytic polypoidal lesion with associated mild circumferential mural thickening.
Cystoscopy was done for the bladder lesion and revealed hematoma with no neoplastic masses.
The renal lesion remains suspicious. Contrast-enhanced MRI was advised for further characterization of the lesion, however, the patient refused to comply.
After three months, the patient presented with acute abdomen and contrast-enhanced CT was done.
There is a right-sided sizable subcapsular renal, perirenal, and retroperitoneal hematoma compressing the underlying kidney and displacing it posteromedially. It elicits heterogeneous hyperdensity in the non-enhanced study. In the post-contrast study, there are linear enhancing bands within, suggestive of mild active bleeding. Associated thickening of perirenal fascia and blurring of fat planes is also noted. No evidence of urine leak.
The patient underwent radical nephrectomy and histopathology revealed multiple cell clusters of renal cell carcinoma.
Case Discussion
Here is a case of spontaneous rupture of renal cell carcinoma leading to a large perinephric hematoma that is an uncommon occurrence. This possibility should be considered in the differential of a spontaneous perirenal hematoma without a history of trauma. Other causes include; vascular causes and coagulation disorders. Angiomyolipoma is the most common renal mass liable to rupture followed by malignant tumors such as RCC 1.
Ultrasound images contribution by Dr. Mohamed Elthokapy.
Unable to process the form. Check for errors and try again.