Spontaneous perirenal and subcapsular haematoma - report of 5 cases

Abstract

Background. Spontaneous perirenal and subcapsular haemorrhage is a rare but important clinical condition and is diagnostically very challenging. Sometimes, the aetiology of bleeding remains unclear; when all available diagnostic possibilities are exhausted, therapeutic approach still remains controversial.

Case reports. We present a series of 5 patients with perirenal and subcapsular bleeding. In two of among our patients, the initial or control CT scan suggested angiomyolipoma and renal cyst as the cause of the bleeding that was confirmed by pathological analyzes. In other three patients, no pathology other than haematoma itself was visualized on CT scans, nor it was discovered on pathological analyzes in two of the patients. Our CT findings closely correlated with pathological findings – whether positive or negative for the pathological substrate. Interestingly, we found not one case of renal cell carcinoma.

Conclusions. In literature, in as many as 50% of cases of perirenal and subcapsular bleeding, a malignant tumour is found. Therefore, by some authors, nephrectomies in all patients are recommended, but others take more expectative approach with long-term close surveillance. We believe, that with new imaging modalities, if using optimal examination technique and follow-up protocols, the patients with bleeding due to benign disease should be recognized and unnecessary nephrectomies avoided.