*38 year-old man with right flank pain
What is the most likely diagnosis?
1. Subcapsular renal hematoma
2. Renal angiomyolipoma
3. Renal cell carcinoma
4. Transitional cell carcinoma
Answer
Answer: Subcapsular renal hematoma secondary to double-J stent insertion
Case Discussion:
Abdominal CT and MRI images show renal subcapsular hematoma (arrow). Abdominal CT image demonstrates stone and double-J stent in the dilated renal pelvis. The renal subcapsular hematoma shows restricted diffusion on DWI. Renal subcapsular hematoma has occurred after double-J stent insertion.
The renal subcapsular area is a potential space where fluid can accumulate, causing compression of parenchyma (1). Renal subcapsular hematoma is not a rare complication after ESWL, double-J stent insertion, trauma, renal angiographic procedures and spontaneously in patients with tumors, vascular diseases, infections, cystic diseases, hydronephrosis, preeclampsia and blood dyscrasias (1-4).
References:
1. Chao YC, Ming HL, Yeu CC, Sun YC. Spontaneous bilateral renal subcapsular hematoma as a possible complication of myeloproliferative disorders. J Med Sci. 2009;29:273–5.
2. Navarro HP, López PC, Ruiz JM. Renal hematoma after extracorporeal shock-wave lithotripsy (ESWL)Actas Urol Esp. 2009;33:296–303.
3. Hsin CY, Jung TS, Wen JW. Spontaneous bilateral subcapsular hematoma of the kidneys: a case report. J Taiwan Urol Assoc. 2008;19:228–31.
4.Akkaya Z, Oksuz N, Coruh AG. A rare complication of a common procedure: Undiagnosed subcapsular renal hematoma after double-J stent insertion. International Journal of Case Reports and Images 2014;5(1):76–79.