Successful Superselective Renal Artery Embolization for the Treatment of Active Renal Bleeding and Large Hematoma after Nephropyelolithotomy

A 22-year-old man who had had percutaneous nephropyelolithotomy seven days previously, was referred to our department for urinary ultrasonography (US), because of high fever (38.5°C) and increased WBC (17700/µL). Following the detection of hyperechogeneities in the dilated collecting system and parenchyma of the right kidney on US, a non-enhanced computed tomography (CT) was planned with the suspicion of bleeding. On CT, large homogeneous-hyperdense areas filling the middle part and lower pole of the kidney primarily suggesting active renal bleeding and hematoma, were seen (Figs. A and B). Because of the progressive decrease in the hemoglobin level one day later, catheter angiography was performed to determine the probable bleeding focus and perform endovascular treatment at the same time, if required. On catheter angiography, contrast extravasation was seen at the subsegmentary arteries in the middle section and inferior pole of the right kidney causing large hyperdense areas on corresponding CT images (Figs. C and D). After superselective diagnostic study of the bleeding small arteries, embolization with nonspherical material was performed without complication. On control angiogram, it was confirmed that the bleeding had stopped (Fig. E). The patient was discharged from the Urology department three days after the endovascular procedure and contacted by phone for follow-up. Comment