Post renal biopsy hematoma

Posted Tue, 04/08/2008 - 12:45 by Shweta Bhatt
Images

Figure 1

Figure 2

Figure 3

Figure 4


Clinical History:

55-yr-old male with history of ultrasound guided renal biopsy . 


Findings:

Figure 1 and 2. Ultrasound of the left kidney immediate post biopsy and after 3 days. Notice the rapid increase in size of peri renal hematoma.

Figure 3. Renal angiogram of the left kidney reveals the site of active bleed. Also note that the needle entered the mid part of the kidney rather than the lower pole.

Figure 4. The bleeder was successfully embolized. 


Diagnosis:

Hematoma secondary to active bleeding after renal biopsy. 


Discussion:

Renal biopsy is an essential procedure in the diagnosis of primary and secondary renal diseases. The technique has significantly improved over the past two decades because of the introduction of ultrasonography and automated-gun biopsy devices. Despite the simplicity of the procedure and the frequency with which biopsies are routinely performed in nephrology units, we still do not know exactly what the rate of postbiopsy bleeding complications is.

Postbiopsy bleeding complications can be categorized as either minor or major. Minor complications included gross hematuria and/or subcapsular perinephric hematoma(5cmdiameter) that spontaneously resolves without need for further intervention. Major complications are those that require an intervention for resolution, either the transfusion of blood products or an invasive procedure such as angiography.

The risks associated with performing a percutaneous renal biopsy have substantially decreased in the past two decades because of technical advances in the method. However, bleeding complications still occur.

Ultrasound helps to guide the procedure of kidney biopsy as well as monitor the post biopsy hematomas. Increase in the size of hematomas on serial ultrasound is concerning for a continuing bleed , and may require an invasive procedure such as embolization. 


References / Suggested Reading:
  1. Manno C, Strippoli GF, Arnesano L, Bonifati C, Campobasso N, Gesualdo L, Schena FP.Predictors of bleeding complications in percutaneous ultrasound-guided renal biopsy. kidney Int. 2004 Oct;66(4):1570-7. 

Author

Shweta Bhatt, MD and Vikram S Dogra , MD

Instructor(S.B.) and Professor of Radiology(V.S.D.)

University of Rochester, NY

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