Presentation
The post-biopsy status of the renal mass includes hematuria, severe abdominal pain, and swelling.
Patient Data
Heterogeneously enhancing soft tissue density mass is seen in the mid and lower poles of the left kidney measuring about 11 x 8 x 7.9 cm.
Diffuse hyperdense mass-like areas are seen in perinephric regions. The lesions result in displacement of the left kidney medially and superiorly.
Left perinephric spaces are completely obliterated. Air densities are seen within the lesion. The left ureter is displaced anteriorly and is compressed. The tail of the pancreas is displaced superiorly. Adjacent bowel loops are displaced.
IVC and mid and distal parts of the left renal vein appear normal. The proximal part of the left renal vein is not well visualized.
Impression: renal mass (possibly RCC) with post-biopsy perinephric hematoma.
Case Discussion
This patient developed severe abdominal pain and hematuria following a percutaneous renal biopsy from the renal mass. The CT scan shows a huge perinephric hematoma.
Perinephric hematoma is one of the most grave complications of percutaneous renal biopsy. Although percutaneous renal biopsy related risks have substantially decreased in the recent past, bleeding complications still occur resulting in increased hospital stay, treatment cost, morbidity and even mortality.
Management of perinephric hematoma depends on the clinical status. Image guided intervention is a relatively safe procedure and preferred over surgery.
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