1 Department of Internal Medicine 2 Department of Radiology 3 Department of Obstetrics and Gynecology and Institute for Clinical Sciences, Chonbuk National University, Medical School, Chonju, South Korea. Email: kwon{at}moak.chonbuk.ac.kr
Sir,
Spontaneous renal subcapsular haematoma is rare and seldom suspected clinically. The characteristic clinical features are abdominal pain, a mass in the flank and signs of internal bleeding. The known causes of spontaneous renal subcapsular haematoma are tumours, vascular diseases, infectious diseases, severe pre-eclampsia and blood dyscrasias [1,2]. Because renal function is decreased in spontaneous renal subcapsular haematoma, early clinical awareness, appropriate investigation and management may be life saving.
Case. A 27-year-old pregnant woman was admitted with complaints of generalized oedema, high blood pressure and headaches. The menstrual age was 34 weeks 5 days. She denied any trauma or drug use. She had no history of bleeding tendency, hypertension, renal disease or easy bruising. On admission, her blood pressure was 170/130 mmHg. Her haemoglobin level was 10.3 g/dl. Urinalysis showed protein 3+. Her renal and hepatic functions were all within the normal range. On the second day, an obstetric examination revealed decreased fetal heartbeats and movements. She complained of blurred vision. An ophthalmological examination showed mild detachment of the retinas. An emergent Caesarean section was performed. On the third post-operative day, her urine amount decreased. Serum creatinine was 4.2 mg/dl. Her blood pressure continued to be >150/100 mmHg despite the Caesarean section. On the next day, she presented with sudden onset of severe left flank pain. Physical examination disclosed marked tenderness and guarding in the left flank. Her haemoglobin level decreased to 7.9 g/dl. An abdominal sonography showed increased size of 13 cm and heterogeneous echogenicity in the entire left kidney. A non-contrast abdominal computerized tomography (CT) revealed a crescentric hyperdense lesion in the subcapsular area of the left kidney. The parenchyma of the left kidney was compressed. Four days later, a follow-up abdominal magnetic resonance imaging (MRI) demonstrated subcapsular lesions of the right kidney in addition to left kidney. T1-weighted image showed heterogeneous low signal intensity and T2-weighted image revealed heterogeneous high signal intensity (Figure 1
). The renal parenchyma was extremely compressed. Because the patient's haemodynamic status was stable and flank pain subsided gradually, we treated her conservatively. Her renal function (serum creatinine 1.4 mg/dl) and haematoma have improved.
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