Spontaneous perinephric hemorrhage in a middle-aged diabetic women

Spontaneous perinephric hematoma is a rare condition that is usually caused by benign and malignant renal tumors, vascular abnormalities and inflammatory disorders. However, a few patients in whom there is no apparent underlying disease are described as having idiopathic spontaneous perinephric hematoma. We report on a middle-aged patient with diabetes mellitus who was hospitalized for sudden onset of right upper flank pain. A large tender mass was palpable in the right upper abdominal quadrant. The hematocrit decreased from 32% on admission to 23% during the following hours. Computerized tomography of the abdomen revealed a large perinephric mass, which was denser than the adjacent renal parenchyma and hypodense after intravenous iodine injection, findings which were compatible with perinephric hematoma. The patient underwent exploratory laparotomy because of hemodynamic instability. Uncontrollable bleeding from a discolored apical renal lesion led to nephrectomy. On pathological examination this apical lesion proved to be a renal infarct with considerable bloody inhibition of perirenal tissues. Extensive search for an underlying disease that led to the infarction was unsuccessful.