Perinephric Hematoma Definition, Symptoms, Radiology, Causes, Treatment

Perinephric hematoma is an uncommon condition that is typically brought on by inflammatory diseases, vascular anomalies, and benign or malignant renal malignancies. Inhibitors of factor Xa, extracorporeal shockwave lithotripsy, and sudden renal rupture can also cause this condition. The standard course of treatment entails conservative management techniques like monitoring and supportive care. More intrusive treatment may be necessary in some circumstances.

Perinephric hematomas can be caused by a wide range of factors, such as trauma to the kidney or the tissues that surround it, medical procedures like kidney biopsy or surgery, or underlying medical diseases including bleeding disorders. Symptoms may include localised discomfort or tenderness, flank pain and reduced urine production.

Definition

A perinephric hematoma is a medical disorder that is characterised by the buildup of blood in the perinephric space, which is the area around the kidney. This area is located in the proximity of the kidney.

Symptoms

An abrupt discomfort in the flank, a mass in the flank, hypovolemic shock, shivering, a high temperature, and retention of urine are all possible signs of a perinephric hematoma. These symptoms are commonly associated with Lenk's triad. Nephritis, renal malignancies, and renal artery aneurysms are just a few of the disorders that can result in perinephric hematomas. Inhibitors of factor Xa or extracorporeal shockwave lithotripsy (ESWL) may play a role in inducing them in some patients. 

Causes

Renal tumours (both benign and malignant), vascular anomalies, and inflammatory diseases are the most common causes of perinephric hematoma. Perinephric hematoma can also be caused by tumour haemorrhage from angiomyolipoma or renal cell carcinoma, vascular disease, systemic lupus erythematosus, prolonged hemodialysis, or polycystic kidney disease. There have also been occasional reports of idiopathic spontaneous perinephric hematomas.

Radiology

Contrast-enhanced CT scans of the abdominal cavity and pelvis are generally performed as part of the diagnostic imaging protocol for perinephric hematoma . Perinephric hematomas are characterised by a collection that is poorly defined and hyper-attenuating, and it can be found between Gerota's fascia and the renal parenchyma. In most cases, the subcapsular or perinephric hematoma is proportionate to the severity of the injury.

Subcapsular and perirenal hematomas can be diagnosed with computed tomography (CT) in addition to other imaging modalities. Moreover, the degree of damage and potential consequences including renal perfusion and hypertension may be assessed using magnetic resonance imaging (MRI). It is also possible to assess split kidney function with a MAG-3 Lasix Renal Scan.

Treatment

The severity of perinephric hematoma and the pathophysiology dictate the therapeutic options available. It may be advised to use conservative treatment in mild cases where the hematoma is tiny and not producing noticeable symptoms. Rest, nonsteroidal anti-inflammatory medicines or acetaminophen for pain control, and careful observation to prevent the hematoma from growing larger may all be part of this treatment plan.

More active treatment may be required in cases when the hematoma is substantial, producing significant pain or compression of the kidney or other structures, or if there is evidence of continuous bleeding. This might comprise:

If the hematoma is tiny and stable, your doctor may opt to observe it and track its progress over time using imaging techniques like CT scan, MRI, or ultrasound.

The doctor may propose a percutaneous nephrostomy, a minimally invasive treatment in which a needle is inserted into the hematoma to remove the accumulated blood, in order to drain the hematoma.

Your doctor can advise surgery to remove the hematoma and treat any underlying damage if the hematoma is large and significantly compressing or damaging the kidney or surrounding structures.

If the hematoma causes severe blood loss, you might need a blood transfusion to replenish the lost blood.

If your doctor determines that your hematoma was caused by anything more serious, such a bleeding disorder, he or she will treat both the hematoma and the underlying cause.