EURORAD ESR

Case 9614

Renal biopsy complication and treatment

Author(s)
Cabral P1, Donato P2, Caseiro-Alves F2

(1) Department of Radiology of Hospital Prof. Dr. Fernando Fonseca, Amadora, Portugal
(2) Department of Radiology of Hospital Universidade Coimbra, Coimbra, Portugal

Hospital Prof Doutor Fernando Fonseca;
Rua Joaquim Rocha Cabral 16 - 4º B
1600-086 Lisboa, Portugal;
Email:pvaldezpt@yahoo.com
 
Patient
female, 53 year(s)
 
 
  • Figure 1
    Renal ultrasound

    Heterogeneous liquid collection in the right flank suggestive of a post-biopsy haematoma.

     
    Area of Interest: Kidney; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;
     
     
  • Figure 2
    Abdominal CE-CT
     

    Axial arterial acquisition. Two haematomas are seen in the right postero-lateral abdominal wall and in the perirenal space pushing the kidney anterior and medially. In both, a linear image of contrast extravasation...

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Portal phase CE acquisition showing that the contrast leakage increases due to active haemorrhage.

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    In this CE coronal reconstruction the active haemorrhagic leak can be seen near the lower pole of the right kidney corresponding to the biopsy needle insertion point.

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Sagittal reconstruction of the same aspects in 2b and 2c. Haemorrhagic leak of the posterior lower pole of the right kidney.

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    In this further CE coronal reconstruction a second active haemorrhagic leak can be seen adjacent to the postero-lateral right abdominal wall, just above the iliac crest.

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Sagittal reconstruction of the same aspects in 2b and 2e. Haemorrhagic leak of the postero-lateral abdominal wall.

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;
     
     
  • Figure 3
    Angiography

    Right kidney renogram. Regular opacification of the kidney with contrast leaking to the perirenal space.

     
    Area of Interest: Interventional vascular; Kidney; Imaging Technique: Catheter arteriography; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;
     
     
  • Figure 4
    Angiography
     

    The actively bleeding distal intralobular branch of the renal artery was selectively catheterised with a microcatheter and embolised using microspheres.

     
    Area of Interest: Interventional vascular; Kidney; Imaging Technique: Catheter arteriography; Procedure: Embolisation; Special Focus: Haemorrhage;

    After the procedure the haemorrhage was successfully stopped. The embolised segment in the lower third of the kidney can be identified as a non-perfused peripheral wedge-shaped region.

     
    Area of Interest: Interventional vascular; Kidney; Imaging Technique: Catheter arteriography; Procedure: Embolisation; Special Focus: Haemorrhage;
     
     
  • Figure 5
    Angiography
     

    The lumbar artery responsible for the lateral abdominal haematoma was also found and selectively catheterised. The active haemorrhage was documented.

     
    Area of Interest: Interventional vascular; Kidney; Imaging Technique: Catheter arteriography; Procedure: Embolisation; Special Focus: Haemorrhage;

    Embolisation of the bleeding lumbar artery with two coils stopped the haemorrhage. Notice that pooled contrast outside the artery persists despite the successful placement of the coils but does not increase with...

     
    Area of Interest: Interventional vascular; Kidney; Imaging Technique: Catheter arteriography; Procedure: Embolisation; Special Focus: Haemorrhage;
     
     
  • Figure 6
    Abdominal CE-CT - 1 week after the embolisation

    Both haematomas have reduced in size and contrast extravasation is no longer present. In the right kidney a peripheral postero-lateral cortical wedge-shaped non-enhancing area corresponding to the post-embolisation...

     
    Area of Interest: Kidney; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;
     
     
Heterogeneous liquid collection in the right flank suggestive of a post-biopsy haematoma.
 
Axial arterial acquisition. Two haematomas are seen in the right postero-lateral abdominal wall and in the perirenal space pushing the kidney anterior and medially. In both, a linear image of contrast extravasation is clearly identified.
 
Portal phase CE acquisition showing that the contrast leakage increases due to active haemorrhage.
 
In this CE coronal reconstruction the active haemorrhagic leak can be seen near the lower pole of the right kidney corresponding to the biopsy needle insertion point.
 
Sagittal reconstruction of the same aspects in 2b and 2c. Haemorrhagic leak of the posterior lower pole of the right kidney.
 
In this further CE coronal reconstruction a second active haemorrhagic leak can be seen adjacent to the postero-lateral right abdominal wall, just above the iliac crest.
 
Sagittal reconstruction of the same aspects in 2b and 2e. Haemorrhagic leak of the postero-lateral abdominal wall.
 
Right kidney renogram. Regular opacification of the kidney with contrast leaking to the perirenal space.
 
The actively bleeding distal intralobular branch of the renal artery was selectively catheterised with a microcatheter and embolised using microspheres.
 
After the procedure the haemorrhage was successfully stopped. The embolised segment in the lower third of the kidney can be identified as a non-perfused peripheral wedge-shaped region.
 
The lumbar artery responsible for the lateral abdominal haematoma was also found and selectively catheterised. The active haemorrhage was documented.
 
Embolisation of the bleeding lumbar artery with two coils stopped the haemorrhage. Notice that pooled contrast outside the artery persists despite the successful placement of the coils but does not increase with additional contrast injection.
 
Both haematomas have reduced in size and contrast extravasation is no longer present. In the right kidney a peripheral postero-lateral cortical wedge-shaped non-enhancing area corresponding to the post-embolisation infarct can be observed.
 
 
 
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