Perinephric Hematoma

Howard T Heller, MD
Ramin Khorasani, MD

July 16, 1997

Presentation

A 74-year-old man presented status post trauma

Imaging Findings

CT images of the abdomen

Contrast-enhanced abdominal computed tomography (CT) images demonstrate a large (8 x 7 cm) left perinephric fluid collection (arrows) arising from the lower pole and extending 13 cm inferiorly. The left kidney is elevated anteriorly. The density of the mass is similar to that of the liver, which is consistent with hematoma. The adjacent Gerota's fascia is significantly thickened and shows blood tracking into the anterior pararenal spaces on both sides, into the peritoneal cavity around the liver (arrows), and into the paracolic gutters. Diffuse subcutaneous edema is present and is most pronounced within the pelvis. Embolization coils are visible in branches of the left renal artery.

Differential Diagnosis

The etiology of perinephric hematoma can be either spontaneous (such as malignant or benign tumor, vascular disease, arteriovenous malformation, hemorrhagic cyst, infection, or infarction) or traumatic (such as blunt or penetrating trauma, purcutaneous nephrotomy, biopsy, surgery, or anticoagulation therapy).

Diagnosis

perinephric hematoma (traumatic etiology)

Discussion

Patients with perinephric hematoma generally present with acute flank pain, and sometimes with hematuria. Computed tomography is the examination of choice for this diagnosis.

References

Siegelman SS, Gatewood OMB, Goldman SM. CT of the kidneys and adrenals. New York: Livingstone, 1984.

Renal vascular disorders. In: Barbaric ZL. Principles of genitourinary radiology. New York: Thieme, 1991.

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