[Spontaneous renal haematoma: diagnostic and therapeutic approach in 7 cases].
OBJECTIVE
Spontaneous renal haematomas are rare. The authors discuss the aetiological diagnosis and management of these haematomas.


METHODS
Seven cases (3 females and 4 males) of spontaneous renal haematoma were managed between July 1999 and December 2002 and the case files were studied retrospectively.


RESULTS
The circumstances of discovery were nonspecific. One patient presented with haemorrhagic shock. Radiological work-up comprised abdominal ultrasound and CT scan in almost every case. Ultrasound failed to demonstrate the aetiological diagnosis. CT revealed the cause of bleeding in 7 cases. MRI was performed in 4 cases, but urgent angiography was not performed. Four total nephrectomies were necessary, while two patients were treated by conservative surgery. One patient was simply followed by repeat CT scan. The short-term course was favourable with a mean follow-up of 23 months.


CONCLUSIONS
Spontaneous renal haematomas raise 2 problems, that of their aetiology: tumours are the commonest causes (angiomyolipoma and renal cell carcinoma), and that of their management. Three therapeutic approaches are possible: radical surgery in the case of uncontrollable bleeding, conservative surgery or surveillance in the absence of a life-threatening emergency and when the aetiological diagnosis has not been established. Rigorous and repeated radiological surveillance can identify the cause of the bleeding allowing conservative surgery to be performed when indicated.
Dubosq
Francis
F
Service d'Urologie, Hôpital Tenon, Paris, France.
Traxer
Olivier
O
Estrade
Vincent
V
Tligui
Mohamed
M
Haab
François
F
Thibault
Philippe
P
Gattegno
Bernard
B
D000368:Aged; D000369:Aged, 80 and over; D003663:Decision Trees; D005260:Female; D006406:Hematoma / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007674:Kidney Diseases / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
Hématomes spontanés du rein: conduite à tenir diagnostique et thérapeutique. A propos de 7 cas.