Spontaneous Subcapsular or Perirenal Haemorrhage Caused by Renal Tumours: A Urological Emergency

Abstract

All the patients presented with flank pain, often severe and associated with a palpable mass and a reduced haemoglobin concentration. Ultrasonography was abnormal in all cases where it was used, but was able to show the tumour and haemorrhage correctly in only one case (13%). Computed tomography had a sensitivity of 71%. Seven patients underwent extrafascial nephrectomy (5 renal cell cancers, 1 malignant oncocytoma and 1 angiomyolipoma) and two with known tuberous sclerosis and bilateral renal angiomyolipomas were treated by superselective embolization. As these few cases were all individual and were collected over a long period of time, general statements about diagnosis and treatment must be approached critically. It may be concluded, however, that spontaneous perirenal haemorrhage is often a surgical emergency necessitating great efforts in terms of diagnosis and treatment. Computed tomography should be performed on all patients nowadays. If the bleeding is caused by a malignant tumour, extrafascial nephrectomy is the treatment of choice. For those with benign tumours selective embolization should be used.

Clinical outcomes of endovascularly managed iatrogenic renal hemorrhages

“…The use of microcatheters for superselective cannulation and embolization of bleeding vessels helps to minimize the loss of renal tissue. [ 9 10 11 12 13 14 15 16 17 ] A bleed can sometimes be detected on the initial aortogram itself [ Figure 3 ]. It may be visualized as an active extravasation of contrast, a pseudoaneurysm [ Figure 4 ], or an arteriocalyceal or arteriovenous fistula [ Figure 5 ].…”

“…[ 6 ] Also, 70-90% of vascular injuries resolve spontaneously,[ 7 ] and treatment is indicated for a massive bleed, deteriorating renal function, or renal hemorrhage which persists for more than 72 h.[ 7 8 ] The treatment of choice is endovascular, with angiography and selective embolization expected to minimize the loss of renal tissue. [ 9 10 11 12 13 14 15 16 17 ]…”

Ewing’s Sarcoma of the Kidney Complicated by a Wunderlich Syndrome

“…The method of choice to identify a Wunderlich syndrome, with a sensitivity of 100%, is the CT scan. The treatment should be chosen depending on the cause either surgery or a more minimally invasive technique: selective renal arterial embolization [ 8 ]. In the discussed case, given the emergency, we preferred the surgical intervention with a therapeutic, as well as a diagnostic, role.…”

Bilateral Spontaneous Perirenal Hemorrhage due to Initial Presentation of Polyarteritis Nodosa

“…However, ultrasonography alone can lead to misdiagnose hemorrhage as a renal tumor or an abscess and cannot identify the etiology of SPH in most cases [ 5 , 6 ]. Contrast enhanced CT has a better sensitivity for diagnosis of SPH with a sensitivity of 79~80% and can also find out the etiology of SPH such as renal mass and renal vascular abnormalities [ 7 , 8 ].…”