Case Study - April 2009

This is a CT scan of the abdomen in a 65-year-old man on dialysis for chronic renal failure who presented with sudden right flank pain radiating to the right groin.

  1. What abnormalities are seen on the CT?
  2. What other investigations might be appropriate?
  3. How should the patient be managed?

Reveal Answer

Open answer There is no fixed answer to this question, however your response should be similar to the one below:

  1. The CT shows multiple cysts in both kidneys and a large haematoma surrounding the right kidney (within the renal capsule) together with stranding in the perinephric fat
  2. Routine blood tests showed his Hb had fallen from a previous value of 11 to 8
  3. Management is conservative with blood transfusion and ongoing dialysis for hyperkalaemia or uraemic symptoms

Further comments
The cystic disease of the kidneys is probably acquired and caused by treatment with lithium for bipolar affective disorder.

No further intervention was required and it was presumed that he had bled into a cyst in the right kidney which, in turn, had then ruptured both within the renal capsule and, beyond it, into the perinephric fat (within Gerota's fascia).

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