Hospital: Hospital Universitario Virgen de la Arrixaca.
Nº: C2019-539
Aut@r o Autores: P. Rey Segovia, D. Gea Martos, I. Sánchez Serrano, M. Ato González, M. Martínez Cutillas, A. Jiménez.
Presentación
A 76-year-old woman was attended at emergency department due to dizziness and oliguria of 2 days of evolution accompanied by very intense abdominal pain at the level of the left flank that radiates to the back. Associated deterioration of general condition and sweating. Supra-therapeutic INR of 8.37 and Hb of 6.2 was observed. Urgent abdominal CT was performed with intravenous contrast and the main findings were: extensive retroperitoneal perirenal and left retroperitoneal hematoma (500cc) with active arterial bleeding on its lower margin. It conditions expansion of the left perirenal space with mass effect and displacement of the renal parenchyma and ipsilateral adrenal gland.
Discusión
Spontaneous retroperitoneal hemorrhage (HRE) is an infrequent clinical syndrome of multifactorial etiology. The main cause is renal tumors, followed by vascular and inflammatory diseases. Several factors, such as heparinization during dialysis, functional platelet abnormalities, intimal arterial fibrosis or oral anticoagulant therapies are often combined to cause a spontaneous kidney hematoma. The diagnosis of this syndrome will be based on clinical symptoms, physical examination, analytical data and radiological study. There are no pathognomonic signs or symptoms, with lumboabdominal pain being the main symptom. The most relevant analytical parameters are the decrease in hemoglobin and hematocrit, leukocytosis and increased levels of urea and creatinine. The current radiological tests (mainly CT) should be the diagnostic pillar of this pathology, not only detecting the retroperitoneal hematoma but also providing an etiological diagnosis that allows us to avoid unnecessary surgical explorations. The therapeutic management will depend fundamentally on the hemodynamic situation of the patient and on the etiology of the bleeding.
Conclusión
The atraumatic renal hemorrhage is an entity, of multiple etiology and difficult to identify given its clinical similarity with other pathologies, however, it can be potentially fatal. For this reason we must know its existence and its potential causes. The index of suspicion should be high in patients admitted to the emergency department with sudden pain in the flank, anemia and hemodynamic instability and we should perform an abdominopelvic CT.
Bibliografía
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