An elderly man with chronic renal failure (on haemodialysis) developed pain in his left upper quadrant which went around into his left flank. He initially presented to his GP where he collapsed and was transferred to hospital.
The aorta is normal. There is a small amount of free fluid seen under the liver edge in the right upper quadrant. No free fluid was seen within the pelvis (not shown).
There is a large, hetrogenous mass in the left upper quadrant lying adjacent and superficial to the small left kidney (incidental renal cysts noted). The mass has no flow within it and has an appearance consistent with haematoma.
The first diagnosis considered in a patient with flank pain and collapse is a ruptured aortic aneurysm. This was excluded with the initial images.
Although a definite diagnosis could not be made, the hetrogenous mass in the right flank adjacent to the kidney suggested a renal haematoma. In this case it was thought secondary to the anticoagulation associated with haemodialysis. Renal angiomyolipomas can also bleed and present in a similar manner.
The patient underwent embolization.