因腎血管病變造成的自發性巨大腎周邊血腫

林毓庭、石宏仁

台北萬芳醫院 泌尿科

Yu-Ting Lin, Hung-Jen Shih

Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

 

Introduction: Perirenal hematoma is most caused by traumatic or iatrogenic injury. Spontaneous rupture of the renal parenchyma with perirenal hematoma is a rare condition. We report a case of a huge perirenal hematoma cause by renal vascular abnormality and treated successful by embolization of renal vessels.

Case Report: This 60-year-old male with history of uncontrol diabetes and hypertension presented with sudden onset of abdominal pain. A computed tomography scan of the abdomen and pelvis discovered a left renal laceration with huge perirenal hematoma. Contrast medium leakage was noted in the hematoma, active arterial bleeding was suspected. Tachycardia with systolic blood pressure around 110 mmHg was noted. Transcatheter arterial embolisation (TAE) was performed and an abnormal tubular structure in the left renal middle pole. The abnormal vessels were embolized with three 3x2mm microcoil and one Hilal microcoil. High blood pressure (systolic blood pressure > 200 mmHg, diastolic pressure > 120 mmHg) was noted since post embolization day1. Blood pressure was controlled with medications and without decrease hemoglobin level on the post embolization day3.

Discussion: Spontaneous renal bleeding caused by congenital renal vascular abnormality should be list in the differential diagnosis when a patient present with perirenal hematoma without trauma history. TAE of abnormal vascular lesion is a treatment option if active bleeding was found.