SHM Converge Scientific Abstract ePoster Gallery-Spontaneous Perirenal Hematoma Presenting With Perplexing Right Upper Quadrant Pain

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This case describes a 74-year-old woman with end-stage renal disease on hemodialysis, hypothyroidism, and atrial fibrillation treated with apixaban. She initially presented after a near-syncopal episode following dialysis and was found to be hypotensive, tachycardic, and in atrial fibrillation with rapid ventricular response. After temporary improvement with fluids, albumin, and antiarrhythmic therapy, she required ICU admission and vasopressors. Because of concern for pulmonary embolism, she was briefly placed on heparin before PE was ruled out and she was returned to apixaban.<br /><br />Several days into hospitalization, she developed right upper quadrant abdominal pain. Ultrasound suggested gallbladder wall thickening but did not show gallstones, making the diagnosis unclear. As her condition worsened, she became hypotensive and her hemoglobin dropped sharply from 11 to 5.9 without evidence of external bleeding. Repeat CT imaging revealed a large right renal subcapsular hematoma with associated perinephric and retroperitoneal hemorrhage measuring about 13 cm. She had known renal cysts, and the bleeding was thought to be spontaneous perirenal/subcapsular hematoma, likely facilitated by anticoagulation and underlying renal disease.<br /><br />This report highlights a rare but important condition: spontaneous perirenal hematoma, which usually presents with flank pain, tenderness, and signs of bleeding (Lenk’s triad), but can occasionally present as right upper quadrant pain and mimic biliary or other abdominal emergencies. CT imaging is more sensitive than ultrasound and may need to be repeated if symptoms evolve. Treatment can include supportive care, transfusion when possible, and arterial embolization; nephrectomy is sometimes required. In this case, the patient refused blood transfusion due to her Jehovah’s Witness faith and later underwent renal artery and lumbar artery embolization, but her anemia progressed and she died on hospital day 17.

Asset Subtitle

Nazia Nawreen

Meta Tag

Author List Khadija Merchant, Nazia Nawreen

Category Clinical Vignettes

Concept Perirenal Hemorrhage

Concept Anticoagulation

Concept Computed Tomography

Concept Abdominal Pain

Concept Flank Pain

Distinguished Non-Finalist

Presenter Organization Capital Health

Presenting Author Nazia Nawreen

Track Adult

Keywords

spontaneous perirenal hematoma

subcapsular renal hematoma

retroperitoneal hemorrhage

hemodialysis

apixaban anticoagulation

atrial fibrillation

end-stage renal disease

right upper quadrant pain

renal artery embolization

Jehovah's Witness

Perirenal Hemorrhage

Anticoagulation

Computed Tomography

Abdominal Pain

Flank Pain