Spontaneous Suburothelial Hemorrhage in Coagulopathic Patients: CT Diagnosis

Abstract

CT findings of suburothelial hemorrhage are often subtle and are best appreciated on unenhanced CT scans because of the high density of the hemorrhage. After contrast injection, uniformly thickened soft tissue enveloping the collecting system is suggestive of this condition. Clinical information regarding the presence of coagulopathy is essential for the radiologist to entertain this relatively rare diagnosis.

Imaging of Iatrogenic Complications of the Urinary Tract

“…2A, B and 3A). 25 Excretory images demonstrate diffuse thickening of the collecting system (see Fig. 2C-E) and occasionally filling defects within the renal pelvis (see Fig.…”

“…3B), making differentiation from malignancy difficult, especially when unilateral. 25,26 This overlap in imaging findings has resulted in nephrectomy for presumed transitional cell carcinoma in approximately 30 cases. 25,[27][28][29] Unenhanced CT in a patient undergoing evaluation for flank pain and hematuria should be carefully scrutinized for high density outlining the renal pelvis, the hallmark of anticoagulant-related hemorrhage.…”

“…25,26 This overlap in imaging findings has resulted in nephrectomy for presumed transitional cell carcinoma in approximately 30 cases. 25,[27][28][29] Unenhanced CT in a patient undergoing evaluation for flank pain and hematuria should be carefully scrutinized for high density outlining the renal pelvis, the hallmark of anticoagulant-related hemorrhage. If unenhanced CT is unavailable and filling defects are present on the excretory phase scan in patients treated with anticoagulants, follow-up CT after anticoagulant treatment withdrawal should be performed.…”

“…3C). 20,25 Awareness of this entity and its radiologic appearance is crucial to prevent an unnecessary surgery.…”

The Renal Sinus—Transitional Cell Carcinoma and its Mimickers on Computed Tomography

“…It presents acutely with flank pain and hematuria and patients undergo CT for evaluation, mainly to evaluate for renal calculi or a neoplastic process such as transitional cell carcinoma. 35 Suburothelial hemorrhage appears on CT as mural thickening of the renal pelvis and sometimes involves also the proximal ureter, sometimes narrowing their lumen. The hemorrhage is best appreciated on un-enhanced scan, when the typical high density of the hemorrhage is most conspicuous (Fig.…”