Spontaneous subcapsular renal hematoma

Case contributed by Angel Romero Domínguez
Diagnosis certain

Presentation

Sudden onset right flank pain, without a history of fever, hematuria or trauma. Patient with end-stage renal disease treated with hemodialysis.

Patient Data

Age: 55 years
Gender: Male

It is observed a right subcapsular pocket of fluid collection, free fluid in right perirenal space, in anterior and posterior right renal facia and in left anterior renal fascia. The Hounsfield units are 40-70(blood).

Both kidneys are reduced in size, with thinned parenchyma and cysts.

The patient was managed conservatively.

A control tomography is performed one week later.

The right subcapsular and perirenal fluid are heterogeneous and have decreased in size. The fluid in left anterior renal fascia has been reabsorbed.

No active bleeding data.

Case Discussion

Patient with end-stage renal disease (ESRD) treated with hemodialysis. Oral use of anticoagulants. 

The findings in initial CT corresponds to a spontaneous subcapsular and perirenal hematoma 3-6. The control CT shows a subacute hematoma decreased in size, without active bleeding data.

End-stage renal disease patients are predisposed to bleeding by multiple factors as severe arterial intimal fibrosis, uremic platelet dysfunction, anemia, increases in nitric monoxide, irregularities in von Willebrand factor and impaired platelet-vessel wall interaction and anticoagulation 1,2.

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