(Fig.1 and Fig. 2)

(Fig. 3 and Fig. 4)

Findings: The CT scan obtained upon admission (Fig. 1) demonstrates a bulbous appearance to the lower pole of the left kidney with extensive retroperitoneal blood adjacent to this. Scans obtained at a lower level show blood tracking down the retroperitoneum posteriorly (Fig. 2). Selective left renal arteriography revealed extravasation from arterial branches in the medial aspect of the lower pole of the left kidney (Image 3). These branches were occluded using a coaxial microcatheter and multiple platinum microcoils (Fig. 4).

Diagnosis: Post-biopsy renal hemorrhage with percutaneous embolization.

Discussion: Up to 90% of patients may have some evidence of hemorrhage following renal biopsy if rigorously imaged. However, hemorrhage requiring transfusion or percutaneous/surgical intervention occur in only approximately 3% of patients. In patients who present with spontaneous perinephric hemorrhage, an underlying lesion must be excluded. However, this patient had undergone multiple previous percutaneous biopsies as recently as five days prior to presentation and thus an underlying lesion was considered unlikely. This patient was initially followed with conservative management but her hematocrit continued to decline despite the transfusion. Therefore, diagnostic arteriography and percutaneous embolotherapy was undertaken.

References:
Hanks SE, Katz MD. Arteriography and Transcatheter Embolization in the
Management of Renal Trauma. Abrams' Angiography. Little Brown, 1997:892-899.

Return to Interventional Imaging Page