Avtor/Urednik		Vukelić-Marković, Mirjana; Huzjan, Renata; Marušić, Petar; Brkljačić, Boris
Naslov		Spontaneous perirenal and subcapsular haematoma - report of 5 cases
Prevedeni naslov		Spontani perirenalni in subkapsularni hematomi - poročilo o 5 bolnikih
Tip		članek
Vir		Radiol Oncol
Vol. in št.		Letnik 38, št. 3
Leto izdaje		2004
Obseg		str. 171-5
Jezik		eng
Abstrakt		Background. Spontaneous perirenal and subcapsular haemorrhage is a rare but important clinical condition and is diagnostically very challenging. Sometimes, the aetiology of bleeding remains unclear when all available diagnostic possibilities are exhausted, therapeutic approach still remains controversial. Case reports. We present a series of 5 patients with perirenal and subcapsular bleeding. In two of among our patients, the initial or control CT scan suggested angiomyolipoma and renal cyst as the cause of the bleeding that was confirmed by pathological analyzes. In other three patients, no pathology other than haematoma itself was visualized on CT scans, nor it was discovered on pathological analyzes in two of the patients. Our CT findings closely correlated with pathologieal findings - whether positive or negative for the pathologieal substrate. Interestingly, we found not one case of renal cell carcinoma. Conclusions. In literature, in as many as 50% of cases of perirenal and subcapsular bleeding, a malignant tumour is found. Therefore, by some authors, nephrectomies in all patients are recommended, but others take more expectative approach with long-term close surveillance. We believe, that with new imaging modalities, if using optimal examination technique and follow-up protocols, tlve patients with bleeding due to benign disease should be recognized and unnecessary nephrectomies avoided.
Izvleček		Izhodišča. Spontana perirenalna in subkapsularna krvavitev je redko, vendar pomembno klinično stanje, ki lahko predstavlja za diagnostika velik izziv. Včasih ostaja etiologija krvavljenja nepojasnjena, čeprav so bili narejeni vsi razpoložljivi diagnostični postopki. V takšnih primerih ostaja tudi odločitev za določeno vrsto zdravljenja kontraverzna. Prikaz primerov. Poročamo o 5 bolnikih z perirenalno in subkapsularno krvavitvijo. V 2 primerih sta prva in kontrolna CT preiskava kazali, da sta verjetni vzrok krvavitve angiomiolipom in ledvična cista, kar je potrdila tudi patohistološka preiskava. V ostalih 3 primerih pa je CT preiskava pokazala le spremembe, ki so kazale na hematom brez, druge patologije in pri 2/3 bolnikih je to potrdil patohistološki pregled. Ugotovitve s CT preiskavo so zelo korelirale s patohistološkimi ugotovitvami tako pri potrditvi kot izključitvi vzroka bolezenskih sprememb. Zanimivo je, da v nobenem primeru nismo našli ledvičnega raka. Zaključki. Po literaturi je kar v 50% vzrok perirenalne in subkapsularne krvavitve maligni tumor. Zato nekateri avtorji v vseh primerih svetujejo odstranitev ledvice, drugi pa svetujejo bolj zadržan pristop z dolgotrajnejšim skrbnim sledenjem bolnika. Menimo, da nam lahko nove slikovne metode, če jih optimalno uporabljamo, in dodatno sledenje bolnika omogočajo, da prepoznamo krvavljenje zaradi benignega obolenja ter se na ta način izognemo nepotrebni odstranitvi ledvice.
Deskriptorji		KIDNEY DISEASES HEMATOMA TOMOGRAPHY, X-RAY COMPUTED SEX FACTORS AGE FACTORS