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Progressive kidney hematoma post-interventional biopsy

Author: Authors: Sebastian Leschka, MD *; Andreas Blaha **
*Institute of Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland
**Business Unit CT, Siemens Healthcare, Forchheim, Germany

History

To determine further therapy, the 21-year-old patient, status after hepatitis B, was referred to the radiology department. Here a biopsy of the renal parenchyma was performed upon which a hemorrhage occurred accompanied by the formation of a hematoma.
A 3-phase kidney CT was performed. Due to the nephritic syndrome only 60 ml of contrast media with a flow rate of 4 ml/s followed by a 60 ml NaCl bolus (4 ml/s) was injected for the kidney CTA.


Diagnosis

In the native phase, an accumulation of liquid at the lower left renal pole was seen. The arterial phase showed an extravasation of contrast media out of the left kidney. An inhomogeneous hematoma measuring 15 x 7.5 x 5 cm was detected around the left kidney. Both kidneys perfused symmetrically, unique renal arteries were seen bilaterally. In the venous phase, a normal renal calyx developed on both sides.


Comments

Despite the low quantity of applied contrast media, an enhancement in the left kidney could be identified due to a quick acquisition time of 0.7 s. The SOMATOM Definition Flash allows a precise and rapid diagnosis with a reduced effective patient radiation dose of 3.27 mSv.

Axial non-enhancement, multiplanar reformation (MPR)
Axial enhancement MPR shows haemorrhages in the kidney hematoma (arrow)
Axial late state MPR shows persistent bleeding (arrow)
Fused VRT/MPR highlighting kidney hematoma
Sagittal non-enhancement MPR
Sagittal enhancement MPR shows haemorrhages in the kidney hematoma (arrow)
Sagittal late state MPR shows persistent bleeding (arrow)

Examination Protocol

Scanner SOMATOM Definition Flash
Scan area Abdomen 3 Phase
Scan length 218 mm
Scan direction Cranio - Caudal
Scan time 0.7 sec
Tube voltage 120/120 kV
Tube current 100 eff. mAs
Dose modulation CARE Dose 4D
CTDIvol 7.71 mGy
DLP 218
Dose 3.27 mSv
Rotation time 0.28 s
Pitch 2.1
Slice collimation 128 x 0.6 mm
Slice width 2 mm
Spatial Resolution 0.33 mm
Reconstruction increment 1 mm
Reconstruction Kernel B30f
Contrast  
Volume 60 ml
Flow Rate 4 ml / sec

The information presented in this case study is for illustration only and is not intended to be relied upon by the reader for instruction as to the practice of medicine. Any health care practitioner reading this information is reminded that they must use their own learning, training and expertise in dealing with their individual patients. This material does not substitute for that duty and is not intended by Siemens Medical Systems to be used for any purpose in that regard.


The drugs and doses mentioned herein are consistent with the approval labeling for uses and/or indications of the drug. The treating physician bears the sole responsibility for the diagnosis and treatment of patients, including drugs and doses prescribed in connection with such use. The Operating Instructions must always be strictly followed when operating the CT System. The source for the technical data is the corresponding data sheets. Results may vary.

Date: 2010-03-10


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