This patient had a transplant kidney biopsy complicated by a large subcapsular hematoma. The hematoma is confined around the kidney, compressing and distorting it. 

Over time, he developed worsening of his hypertension and worsening renal function. CO2 angiography excluded a treatable bleeding source such as AVM or false aneurysm.

Percutaneous drainage was initially unsuccessful due to the thick nature of the clot. Over time, the hematoma liquefied and some of it was evacuated via a percutaneous drain tube. Surgical evacuation of the clot carries a high risk of nephrectomy and was thus avoided.