case_images: PMC7223858_01
case_images: Computed tomography of abdomen with contrast demonstrating small amount of fluid in the right Gerota's fascia (red arrow) with a subtle fracture of the upper pole of the right kidney.
case_images: 10.1177_2324709620918098-fig1.jpg
case_images: PMC7223858_01_10.1177_2324709620918098-fig1.jpg
case_images: fig1-2324709620918098
case_images: Past medical history is significant for uncontrolled diabetes mellitus type 2, bipolar disorder, and a history of motor vehicle accident 7 years prior that resulted in traumatic brain injury and residual mild cognitive impairment, pelvic fractures status-post open reduction with internal fixation, and a right-sided renal laceration that was managed conservatively (Figure 1).
case_images: Computed tomography abdomen and pelvis without contrast showing evidence of large bilateral subcapsular renal hematomas (yellow arrows), left greater than right, with attenuation within these hematomas concerning for acute intermittent bleeds (blue arrows).
case_images: 10.1177_2324709620918098-fig2.jpg
case_images: PMC7223858_01_10.1177_2324709620918098-fig2.jpg
case_images: fig2-2324709620918098
case_images: Computed tomography (CT) of abdomen and pelvis without contrast demonstrated evidence of large bilateral subcapsular renal hematomas, left greater than right, with attenuation within these hematomas concerning for acute intermittent bleeds (Figure 2).
case_images: Triple-phase computed tomography of abdomen (A) and pelvis (B) demonstrates progression of the left-sided subcapsular hematoma measuring 10.7 x 10.7 x16.8 cm with visualization of arterial extravasation on the left kidney (orange arrows).
case_images: 10.1177_2324709620918098-fig3.jpg
case_images: PMC7223858_01_10.1177_2324709620918098-fig3.jpg
case_images: fig3-2324709620918098
case_images: One hour later, CT angiography of the abdomen and pelvis with triple-phase contrast to localize the source of bleeding showed that the left-sided subcapsular hematoma appears to have increased in size from 8.4 x 7.8 x 15 cm on the prior CT to 10.7 x 10.7 x16.8 cm, as well as evidence of active arterial extravasation from the left renal artery into the retroperitoneum (Figure 3).