84-year-old woman with a history of hypertension, hyperthyroidism, type II diabetes mellitus and anxiety syndrome.
She was referred to the C. Externa de Urología from the Emergency Department due to a clinical picture of monosymptomatic frank hematuria of several weeks duration without other associated symptoms or alteration of the general state.
Physical examination revealed a palpable mass in the right lumbar fossa.
The abdomen was blushing and depressible.
The ultrasound examination showed a large heterogeneous solid mass in the lower pole of the right kidney with normal contralateral kidney.
The bladder showed internal echoes compatible with clots.
The cystoscopic study was anodyne.
CT scans of the abdomen, chest X-ray, blood chemistry and blood count were performed.
CT showed a large right-sided mass of 9x10 cm heterogeneous and hypophyseal zones inferior to necrosis areas) with distortion of the renal parenchyma and its contour, located in the lower pole and with attenuation values.
The renal vein was thrombosed and there were retroperitoneal locoregional lymph nodes.
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Laboratory findings included iron deficiency anemia, increased ESR and normocalcemia.
Radical surgery is proposed that the patient and family reject and as an alternative selective embolization is accepted.
Abdominal aorta arteriography was performed by puncture in the right common femoral artery and the right renal artery was selectively catheterized with a visceral angiographic catheter Cobra 2 of 5 Fr (Angiodinamics®).
The artery that irrigates the tumor is then embolized with polyvinyl alcohol particles (PVA) from 355 to 500 without complications (Contour®, Boston Scientific) occluding its flow.
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After 24 hours of hospitalization, given the good evolution of the patient, it was decided to hospital discharge pending successive controls.
Two weeks after embolization, the patient complained of headache, and a brain CT scan showed no pathological findings.
After 28 months of follow-up, episodes of hematuria have not recurred and the only remarkable symptomatology is insomnia and musculoskeletal pain, both controlled with symptomatic treatment.
Blood pressure values have not been modified maintaining acceptable levels with ACEIs and calcium antagonists.
