Mao Y, De Oliveira I S, Hedgire S, Prapruttam D, Harisinghani M
Department of Radiology, Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400061, China.
Division of Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA.
Clin Radiol. 2017 Feb;72(2):175.e19-175.e26. doi: 10.1016/j.crad.2016.08.010. Epub 2016 Oct 6.
To evaluate the aetiology, imaging features, and the evolution of spontaneous perirenal haemorrhage detected by imaging.
In this retrospective study, the hospital database was searched for all cases of spontaneous perinephric haemorrhage detected by imaging between January 2000 and December 2012. Imaging examinations were reviewed and the following parameters were recorded: the location, extension, and total volume of the haematoma, presence of active extravasation, the haematocrit effect, and highest density. The resolution time was calculated using follow-up imaging. The final aetiology for all cases was assessed via clinical, radiological, and histopathological data. Differences in imaging features of haemorrhage according to aetiology group were analysed with independent samples test and Fisher's exact test.
Eighty-one haematomas were identified in 78 patients during this 13-year period. Causes of perirenal haemorrhage included coagulation disorders (22/81, 27.1%), ruptured renal cyst (11/81, 13.6%), rupture of abdominal aortic aneurysm (9/81, 11.1%), renal cell carcinoma (9/81, 11.1%), adrenal masses (9/81, 11.1%), polycystic kidney disease (7/81, 8.6%), angiomyolipoma (6/81, 7.4%), renal vascular diseases (2/81, 2.4%), and recurrent pyelonephritis (1/81, 1.2%). Haematomas associated with coagulation abnormalities and vascular diseases presented with larger volumes and were more likely to extent to the pararenal space more so than other groups; ruptured renal cyst and renal cell carcinomas tended to be more associated with subcapsular haematomas. The haematocrit effect and haemorrhage involving renal parenchyma were more often observed in the group with coagulation abnormalities.
Imaging features, such as location and extension, could help radiologists identify possible aetiologies of spontaneous perirenal haemorrhage.
评估影像学检查发现的自发性肾周出血的病因、影像学特征及病情演变。
在这项回顾性研究中，检索了医院数据库中2000年1月至2012年12月期间所有经影像学检查发现的自发性肾周出血病例。回顾影像学检查并记录以下参数：血肿的位置、范围、总体积、是否存在活动性出血、血细胞比容效应及最高密度。通过随访影像学检查计算消散时间。通过临床、放射学和组织病理学数据评估所有病例的最终病因。采用独立样本检验和Fisher精确检验分析不同病因组出血的影像学特征差异。
在这13年期间，78例患者中发现了81个血肿。肾周出血的病因包括凝血功能障碍（22/81，27.1%）、肾囊肿破裂（11/81，13.6%）、腹主动脉瘤破裂（9/81，11.1%）、肾细胞癌（9/81，11.1%）、肾上腺肿块（9/81，11.1%）、多囊肾病（7/81，8.6%）、肾血管平滑肌脂肪瘤（6/81，7.4%）、肾血管疾病（2/81，2.4%）及复发性肾盂肾炎（1/81，1.2%）。与凝血异常和血管疾病相关的血肿体积较大，比其他组更易延伸至肾旁间隙；肾囊肿破裂和肾细胞癌更易与包膜下血肿相关。凝血异常组更常观察到血细胞比容效应和累及肾实质的出血。
血肿的位置和范围等影像学特征有助于放射科医生识别自发性肾周出血的可能病因。
