• Registration
  • Login
JETem
  • Home
  • About
    • Aim and Scope
    • Our Team
    • Editorial Board
    • FAQ
  • Issues
    • Current Issue
    • Ahead of Print
    • Past Issues
  • Visual EM
    • Latest Visual EM
    • Search Visual EM
    • Thumbnail Library
  • For Authors
    • Instructions for Authors
    • Submit to JETem
    • Photo Consent
    • Policies
      • Peer Review Policy
      • Copyright Policy
      • Editorial Policy, Ethics and Responsibilities
      • Conflicts of Interest & Informed Consent
      • Open Access Policy
  • For Reviewers
    • Instructions for JETem Reviewers
    • Interested in Being a JETem Reviewer?
  • Topic
    • Abdominal / Gastroenterology
    • Administration
    • Board Review
    • Cardiology / Vascular
    • Clinical Informatics, Telehealth and Technology
    • Dermatology
    • EMS
    • Endocrine
    • ENT
    • Faculty Development
    • Genitourinary
    • Geriatrics
    • Hematology / Oncology
    • Infectious Disease
    • Miscellaneous
    • Neurology
    • Ob / Gyn
    • Ophthalmology
    • Orthopedics
    • Pediatrics
    • Pharmacology
    • Procedures
    • Psychiatry
    • Renal / Electrolytes
    • Respiratory
    • Social Determinants of Health
    • Toxicology
    • Trauma
    • Ultrasound
    • Urology
    • Wellness
    • Wilderness
  • Modality
    • Curricula
    • Innovations
    • Lectures
    • Oral Boards
      • Structured Interview
      • Communication Case
    • Podcasts
    • Simulation
    • Small Group Learning
    • Team Based Learning
    • Visual EM
  • Contact Us

Computed Tomography and Ultrasound Diagnosis of Spontaneous Subcapsular Renal Hematoma

Samer Assaf, MD*, Thalia Nguyen* and Alisa Wray, MD*

*University of California, Irvine, Department of Emergency Medicine, Orange, CA

Correspondence should be addressed to Samer Assaf, MD at sassaf86@gmail.com

DOI: https://doi.org/10.21980/J8062DIssue 3:1
Renal/ElectrolytesVisual EM
No ratings yet.

Creative Commons images
Creative Commons images
Creative Commons images

History of present illness:

A 58-year-old female with history of thrombotic disorder presented to emergency department (ED) with constant, sharp pain in her lower abdomen radiating to her back for the past day. She denied nausea, vomiting, changes in bowel habits, or recent abdominal trauma. The patient had been recently transitioned from warfarin to enoxaparin after having a shoulder surgery one week prior to her presentation. On exam, the patient was tachycardic, hypotensive, and pale. She had significant abdominal tenderness to the left upper and lower quadrants, and left flank. Her initial hemoglobin (Hbg) was 8.9 g/dL, but dropped to 6.1 g/dL during her ED course, requiring emergent blood transfusion.

Significant findings:

Bedside ultrasound was performed and demonstrated a hypoechoic area within the left kidney (images not shown). The non-contrast computed tomography (CT) of the abdomen and pelvis shows a significantly enlarged left kidney and a region of high-attenuation encapsulating the left kidney, concerning for acute hemorrhage.

Discussion:

The cause for spontaneous subcapsular renal hematoma (SPH) is not entirely clear.1 It may mimic acute appendicitis or a dissecting aneurysm.2 The use of ultrasound in the emergency setting can detect SPH; however, CT is preferred because it can distinguish between a renal mass, abscess, or collection of blood.3 Most SPH cases are associated with renal tumors, and radical nephrectomy is recommended.4 When the etiology cannot be determined, conservative management may be appropriate.5 The use of anticoagulant and antiplatelet medications may be a predisposing factor, since their usage has been implicated in cases of SPH in the past.4,6 This patient was evaluated by interventional radiology, but she was not a candidate for embolization due to a significant contrast allergy. She was therefore admitted to general surgery and underwent exploratory laparotomy. A left-sided adrenal mass was discovered with retroperitoneal and splenic hemorrhages, necessitating splenectomy and left adrenalectomy.

Topics:

Spontaneous perirenal hematoma, spontaneous subcapsular hematoma, anticoagulation, computerized tomography, CT, ultrasound.

References:

  1. Phillips CK, Lepor H. Spontaneous retroperitoneal hemorrhage caused by segmental arterial mediolysis. Rev Urol. 2006;8(1):36-40.
  2. Orr WA, Gillenwater JY. Hypernephroma presenting as an acute abdomen. Surgery. 1971;70(5):656-60.
  3. Lai S and Spanger M. Role of computed tomography in perirenal haematoma; a pictorial review. Internet J Radiol. 2012;14(1):1-9.
  4. Toutziaris C, Spyridon K, Leonidas L, Koptsis M, Sardaridis F, Ioannidis S. Spontaneous subcapsular renal hematoma in a patient being treated with dual antiplatelet therapy: a case report. International Journal of Case Reports and Images.2012;3(12):43–45. doi: 10.5348/ijcri-2012-12-236-CR-10
  5. Bosniak MA. Spontaneous subcapsular and perirenal hematomas. Radiology. 1989;172(3):601–2.doi: 10.1148/radiology.172.3.2772165
  6. Greco M, Buttice S, Benedetto F, Spinelli F, Traxer O, Tefik T, et al. Spontaneous subcapsular renal hematoma: strange case in an anticoagulated patient with HWMH after aortic and iliac endovascular stenting procedure. Case Rep Urol. 2016:2573476. doi: 10.1155/2016/2573476
Icon

Subcapsular Hematoma - Case Report

1 file(s) 563 KB
Download
Icon

Subcapsular Hematoma - Images

1 file(s) 35 MB
Download
CTIssue 3:1Ultrasound

Reviews:

No ratings yet.

Please rate this





Creative Commons images

Point-of-care Ultrasound for the Diagnosis of a...

08 Jan, 18
Creative Commons images

A Case of Acute Cholecystitis

08 Jan, 18

JETem is an online, open access, peer-reviewed, journal-repository for EM educators. We are PMC Indexed.

Most Viewed

  • The Silent Saboteur: Teaching the Clinical Implications of Occult Hypoxemia & Social Determinants of Health via a Pulmonary Embolism Case
  • Diabetic Ketoacidosis and Necrotizing Soft Tissue Infection
  • My Broken Heart
  • Stabilization of Cardiogenic Shock for Critical Care Transport, a Simulation
  • Innovative Ultrasound-Guided Erector Spinae Plane Nerve Block Model for Training Emergency Medicine Physicians

Visit Our Collaborators

Creative Commons Licence
This work is licensed under a Creative Commons Attribution 4.0 International License.

About

Education

Learners should benefit from active learning. JETem accepts submissions of team-based learning, small group learning, simulation, podcasts, lectures, innovations, curricula, question sets, and visualEM.

Scholarship

We believe educators should advance through the scholarship of their educational work. JETem gives educators the opportunity to publish scholarly academic work so that it may be widely distributed, thereby increasing the significance of their results.

Links

  • Home
  • Aim and Scope
  • Current Issue
  • For Reviewers
  • Instructions for Authors
  • Contact Us

Newsletter

Sign up to receive updates from JETem regarding newly published issues and findings.

Copyright Creative Commons Attribution 4.0 International