Spontaneous Retroperitoneal Hematoma: A Rare Presentation of Polyarteritis Nodosa

Ullah, Asad; Marwat, Asghar; Suresh, K.; Khalil, Ahmed; Waseem, Saba

doi:10.1177/2324709619858120

Cited by 5 publications

(3 citation statements)

References 7 publications

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“…The pathogenesis of spontaneous renal bleeding is poorly understood and the literature draws from case reports. For example, it could be associated with warfarin use [12] or vasculitis and immune diseases [13]. The spontaneous subgroup in the current series had similar demographic characteristics to the overall study population with the exception of a lower mean ± SD age (28 ± 9 years versus 44 ± 14 years), which could suggest the predominance of these lesions in younger patients.…”

Section: Discussionmentioning

confidence: 50%

Negative renal angiography with subsequent denied angioembolization: findings in a series of 180 patients at a tertiary interventional uroradiology unit

Farg

Elawdy

Soliman

et al. 2022

Egypt J Radiol Nucl Med

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Background Renal arterial embolization (RAE) is considered to be a safe and effective method for treating a variety of renal lesions and pathology. It is the optimal method not only to stop bleeding, but to preserve renal parenchyma and renal function. Patients who are scheduled to RAE who showed negative catheter angiography with the procedure subsequently denied have a special concern because they are subjected to unnecessary procedure with its complications and didn’t get its benefits. This circumstance is infrequently reported in the literature, and that compelled us to identify the predictors of negative renal angiography findings that would result in a failure to undertake RAE. Results The study included 180 patients (126 males; 70%) with a mean ± SD age of 44 ± 14 years. Iatrogenic causes were the most common indication for RAE (108 of 180; 60%), while spontaneous unknown reasons constituted (17 of 180 patients; 9%). Angiography showed various lesions in 148 patients: pseudoaneurysm (80 of 148; 54%), tumours (28 of 148; 19%), arteriovenous (AV) fistulas (22 of 148; 15%) and both pseudoaneurysm and AV fistulas (18 of 148; 12%). However, in the remaining 32 of 180 patients (18%) no lesions were identified on renal angiography and RAE procedures were not undertaken. On bivariate analysis, neither gender, side of the lesions, haematuria prior to RAE, or renal artery anatomy were predictors for negative angiography. However, the indication for RAE (spontaneous unknown reasons) of renal haemorrhage was the only predictor for negative angiography (9/17 (53%), P = 0.001). Conclusion Patients scheduled for RAE may show negative findings with no lesions on renal angiography. Among the different indications for RAE, patients with spontaneous (unknown) have the highest probability (53%) of being associated with negative renal angiography findings, however, those with renal tumours and post-traumatic causes have a low probability. In those patients with spontaneous (unknown), conservative management should be the initial treatment of choice in order to avoid unnecessary RAE and its associated complications.

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Section: Discussionmentioning

confidence: 50%

Negative renal angiography with subsequent denied angioembolization: findings in a series of 180 patients at a tertiary interventional uroradiology unit

Farg

Elawdy

Soliman

et al. 2022

Egypt J Radiol Nucl Med

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“…Currently, transcatheter selective renal artery embolization is typically performed instead of nephrectomy. With this therapy, favorable outcomes have been reported, regardless of embolic material, unilateral, or bilateral hematoma [ 6 , 12 – 15 ]. The procedure-related mortality of selective embolization is 3.6% [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Polyarteritis nodosa with perirenal hematoma due to the rupture of a renal artery aneurysm

et al. 2020

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We present the case of a 67-year-old man in good health with perirenal hematoma due to a ruptured arterial aneurysm in the kidney. The patient developed weight loss, muscle weakness, multiple mononeuropathy, hypertension, anemia, renal insufficiency, and multiple lacuna infarctions about a month ago. He was admitted to the hospital due to worsening of his symptom. After admission, severe right-flank pain suddenly occurred; he was then transferred to our hospital. Renal angiography revealed bilateral multiple microaneurysms, and the patient was diagnosed with polyarteritis nodosa based on the clinical, radiographic, and histological findings. We performed selective coil embolization to the ruptured aneurysm and administered oral prednisolone along with intravenous methylprednisolone pulse therapy. Cyclophosphamide pulse therapy was also given. The treatment improved clinical and laboratory findings and achieved clinical remission. Selective coil embolization to the bleeding aneurysm of polyarteritis nodosa was minimally invasive and promptly effective. Immunosuppressants proved useful in the regulation of disease activity and the aneurysm.

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“…Initially, rupture of an aortic aneurysm and left iliac artery was suspected, but examination of the lower limbs revealed the presence of arterial pulse to distality. Spontaneous renal rupture or Wunderlich syndrome, another cause of non-traumatic retroperitoneal hematoma, has been suspected [ 8 ]. Spontaneous rupture of the adrenal gland was taken into account, although it was found that this pathology is more common in young women [ 9 , 10 ].…”

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confidence: 99%

Spontaneous Left External Iliac Vein Rupture

et al. 2022

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Spontaneous rupture of the Iliac Vein is very rare in practice. In over 90% of cases, the venous lesion is located on the left side. The exact etiology of this condition is unknown. Spontaneous injury of the iliac vein is thought to be favored by intense exercise, constipation, cough, labor, May-Thurner syndrome or pre-existing inflammatory changes in the venous wall are also implicated. We present the case of an 83-year-old woman who is brought to the Emergency Department for abdominal pain located in the left flank and in the left iliac fossa, which appeared after a medium physical exertion. After an emergency contrast-enhanced abdominal CT scan, the diagnosis of spontaneous rupture of the left external iliac vein is established. Surgery is performed with extreme urgency by retroperitoneal approach and due to the very precarious condition of the patient, venous ligation is done, wishing to perform a Palma-Dale venous bypass at a later time. Although a rare cause of spontaneous retroperitoneal hematoma, a non-traumatic rupture of the common or external iliac vein should be considered in patients in shock with massive retroperitoneal bleeding, accompanied by a high mortality rate.

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Spontaneous Retroperitoneal Hematoma: A Rare Presentation of Polyarteritis Nodosa

Cited by 5 publications

References 7 publications

Negative renal angiography with subsequent denied angioembolization: findings in a series of 180 patients at a tertiary interventional uroradiology unit

Negative renal angiography with subsequent denied angioembolization: findings in a series of 180 patients at a tertiary interventional uroradiology unit

Polyarteritis nodosa with perirenal hematoma due to the rupture of a renal artery aneurysm

Spontaneous Left External Iliac Vein Rupture

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