Subcapsular renal hematoma complicating acute pyelonephritis

A case-report of chromophobe renal cell carcinoma with renal subcapsular hematoma

INTRODUCTION AND IMPORTANCE

Chromophobe renal cell carcinoma (CHRCC) is a rare subtype of renal cancer, accompanied by subcapsular renal hematoma (SRH) without a history of traumatic or hemorrhagic disease, which is clinically rare. The reason for CHRCC with SRH may be caused by tumor rupture or vascular rupture. In the early stage, it is often asymptomatic and can be easily overlooked and misdiagnosed, leading to delayed treatment and serious consequences.

CASE PRESENTATION

A 39-year-old female patient was admitted to the emergency department due to sudden dull pain and discomfort in the lower back. Subsequent ultrasound, CT, and MRI imaging examinations revealed the presence of chromophobe renal cell carcinoma with a volume of 4.5 × 3.5 × 3 cm in the middle and lower pole of the right kidney. In addition, a subcapsular hematoma with an area of approximately 6 × 11 cm was also found. The patient underwent laparoscopic radical nephrectomy.

CLINICAL DISCUSSION

Due to its atypical syptmoms and signs, it is often overlooked or misdiagnosed. CHRCC has unique histological features, which distinguish it from other subtypes of renal cell carcinoma. Imaging studies such as CT scan and MRI are helpful in diagnosing and identifying associated complications. In this case, the presence of the perirenal hematoma is a notable finding, which may be caused by tumor-induced vascular disruption.

CONCLUSION

This report underscores the importance of recognizing and managing complications associated with CHRCC. Early diagnosis and appropriate surgical treatment are crucial for favorable outcomes in these cases.

Wunderlich syndrome in a patient with pyelonephritis

An elderly female patient with left pyelonephritis developed worsening left flank pain, hypotension and a drop in haemoglobin (Hb) from 97 g/L to 67g/L on the third day of her admission. There was no recent trauma, history of coagulopathy or risk factors for renal malignancy or vascular disease.A contrasted CT scan of the kidneys revealed a 3.8 cm left renal subcapsular haematoma with no active contrast extravasation. Her atraumatic subcapsular haematoma fulfils two out of three clinical features of Lenk's triad (acute flank pain, hypovolaemic shock), suggestive of Wunderlich syndrome. Urine and blood cultures grew Klebsiella pneumoniae and she was managed conservatively with culture-directed antibiotics, fluids and blood products.Wunderlich syndrome is a rare complication of pyelonephritis and should be considered in patients with pyelonephritis who develop acute severe flank pain, Hb drop and haemodynamic instability. Appropriate medical and surgical therapies need to be instituted early to ensure good outcomes.

Spontaneous Subcapsular Renal Hematoma as a Complication of Acute Pyelonephritis: A Case Report

Spontaneous subcapsular renal hematoma (SSRH) emerged as a complication of acute pyelonephritis (APN) is an extremely rare condition. We showed a patient aged 63 years hospitalized due to languor, febrility, abdominal pain accompanied by nausea and vomiting. Ultrasound (US) examination of the abdomen and multidetector computed tomography (MDCT) showed the presence of subcapsular hematoma of the left kidney with calculus in the initial part of the left ureter. Laboratory tests registered a positive inflammation syndrome, anemia and an increase in nitrogen compounds. Based on laboratory results, clinical presentation and imaging techniques it has been found that it is APN with spontaneous subcapsular hematoma. After application of non-surgical treatment which included antibiotic therapy with percutaneous drainage of hematoma, a good clinical response with regression of subjective symptoms and hematoma was obtained. On repeated US and MDCT after 18 months no pathological changes in the kidneys were registered. Spontaneous subcapsular hematoma extremely rare occurs as a result of APN associated with calculosis. The use of non-surgical treatment, which includes appropriate antibiotic therapy with percutaneous drainage of hematoma would represent a method of first choice.

Emphysematous pyelonephritis initially presenting as a spontaneous subcapsular hematoma in a diabetic patient

Emphysematous pyelonephritis (EPN) is a life-threatening infection characterized by the formation of gas. Complications of EPN include septic shock, acute renal failure, and disseminated intravascular coagulation. Spontaneous subcapsular hematoma (SCH) has also been reported as a rare complication of EPN, although there have been no reports to date of this occurring prior to the presentation of EPN. We report a case of EPN that initially presented as spontaneous SCH. The patient was admitted for left flank pain, and initial computed tomography revealed SCH without any air shadows. Laboratory findings and clinical symptoms suggested the presence of urinary tract infection and the patient was started on antibiotics. Fever developed 24 hours after admission. On follow-up computed tomography 7 days later, EPN was newly observed, and a percutaneous drain was inserted. Blood, urine, and drainage fluid cultures all revealed growth of extended-spectrum β-lactamase-negative Escherichia coli.