Abstract: FR-PO632
Spontaneous, Non-Traumatic Rupture of an Acquired Renal Cyst in ESRD Patient with Large Retroperitoneal Hemorrhage - A Case Report
Session Information
- Trainee Case Reports - IV
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Raza, Abbas, Drexel University , Philadelphia, Pennsylvania, United States
- Aggarwal, Sandeep, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
- Hanif, Muhammad Owais, Drexel University , Philadelphia, Pennsylvania, United States
Introduction
Acquired Cystic Kidney Disease (ACKD) is asymptomatic in most patients. However, the renal cyst may be associated with back pain, infection, and malignant transformation. Cyst rupture and bleeding secondary to ACKD are considered unlikely because of reduced renal parenchymal blood supply in atrophic kidneys. We present a case of an End Stage Renal Disease (ESRD) patient with a previously unrecognized cystic condition who presented with extensive retroperitoneal hemorrhage.
Case Description
A 31-year-old male with the medical history of ESRD for 5 years due to hypertension and no history of smoking presented with acute onset of left flank pain. Patient denies any traumatic event prior to the onset of pain. Blood work showed a hemoglobin of 9.5 g/dl with normal coagulation profile and platelets. Imaging showed large heterogeneously attenuating, ruptured left renal/perinephric hematoma measuring 10x12x27 cm occupying most of the left retroperitoneal space and extending across the midline. There were multiple foci of active extravasation and no normal renal parenchymal tissue was visualized. (Figure-1). The patient had an emergent fluoroscopy guided coil and Gelfoam embolization of the superior and inferior pole left renal arteries with successful hemostasis. The patient remained hemodynamically stable for the rest of the stay.
Discussion
To our knowledge, it is the first reported case of ACKD associated massive hemorrhage. Although rare, hemorrhage due to ruptured renal cyst should be suspected when an ESRD patient presents with acute back pain and symptoms of shock. Screening for ACKD has been proposed but larger scale trials are required for consensus and guideline development.
Figure 1: CT scan image. Red asterisk on the left of the patient indicating the area of retroperitoneal hemorrhage. Note right atrophic kidney (yellow asterisk).