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Background: Flank pain, abdominal pain and hematuria are common complaints in emergency medicine. Case report: We describe the case of a 72-year-old female who presented to the emergency department for worsening left lower quadrant abdominal pain and left flank pain associated with new-onset hematuria. The patient reported that the pain began immediately after she accidently tripped on a rock which resulted in a forceful twist of her body and catching herself with her hands without any direct impact to her body. A delayed contrast enhanced CT showed evidence of left kidney rupture with leakage of the contrast dye through the left renal calyx into the lower part of the abdomen and musculature. Why should an emergency physician be aware of this?: Flank/abdominal pain with or without hematuria are common ED complaints. In this case, the combination of a good history and physical examination in conjunction with delayed CT imaging ultimately led to the correct diagnosis of a kidney rupture. It is important to note that immediate and delayed contrast enhanced CT remains the gold standard in diagnosis of this condition. The treatment of kidney rupture is dependent on the stability of the patient. Hemodynamically stable patients should be treated with conservative management, while hemodynamically unstable patients should be treated with either angioembolization by interventional radiology or with stenting or nephrectomy by surgery.

Xanthogranulomatous pyelonephritis (XGP) is an uncommon and aggressive form of inflammation of the renal parenchyma particularly resulting in diffuse renal destruction. A previously healthy 25-year-old woman was admitted to our clinic with right flank pain of sudden onset, nausea and high fever. Computed tomography revealed a mass (12 x 7 cm in diameter) around the right kidney with extension to pelvis and paravertebral space. Flank incision was made urgently and a very large perirenal haematoma and abscess formation were found caused by the rupture located at the posterior side of the right kidney. A right nephrectomy was performed and abscess material was evacuated from the perirenal area. XGP was diagnosed by histopathologic examination of the resected kidney. Although XGP regularly demonstrates a gradual progression and presents with nonspecific symptoms, the situation may appear with complications as in our case. Our patient presented with renal rupture and perirenal abscess extending to the pelvis and paravertebral space. To the best of our knowledge, this is the first report of XGP presenting with spontaneous renal rupture in the English literature. [ABSTRACT FROM AUTHOR]

Kidney spontaneous rupture is not a recognized complication neither for amyloidosis nor of autologous stem cell transplantation (ASCT). A 46-year-old white woman, affected by nephrotic syndrome, was diagnosed as AL amyloidosis by renal biopsy. We report the singular case of a bilateral spontaneous kidney rupture during ASCT for AL with renal rescue. [ABSTRACT FROM PUBLISHER]

The hydrostatic pressure, intrapelvic volume, and specific elasticity and strength of strips of tissue from the parenchyma and the pelvis of eight hydronephrotic kidneys were investigated and compared with the tissue characteristics of the pelvis of four control kidneys. Hydronephrosis manifested itself by a sixfold reduction of tissue strength, and dynamically by a ninefold reduction of the energy absorptive capacity of the parenchyma as compared with the pelvis. Its further response to trauma appeared to be influenced by internal pressure, the law of mass variation, and the energy absorptive capacity of surrounding anatomical structures. The vulnerability of the hydronephrotic kidney in situ depends on its volume and topography, the parenchyma being the part that may be regarded as the site most predisposed to rupture. [ABSTRACT FROM AUTHOR]

Objective To review published cases of rupture of the urinary tract during pregnancy and illustrate the clinical manifestations of this serious complication of pregnancy. Methods Reported cases of urinary tract rupture were reviewed and a new case described. Results Spontaneous rupture of the urinary tract during pregnancy is rare; a review of the literature revealed only 24 cases, most commonly occurring in diseased kidneys. In the majority of cases the rupture was associated with underlying diseases of the kidney, the most common being renal tumours. Of the 25 cases examined, 12 had ruptures of the collecting system and 13 had ruptures of the renal parenchyma; 21 were diagnosed during pregnancy in the second and third trimester and four within the first 24 h postpartum. Conclusion Pregnancy-induced changes in the urinary tract exaggerate any weakness of the parenchyma or collecting system. Pregnant patients with overdistension of the upper urinary tract should undergo routine ultrasonography and be observed carefully for infection or haematuria. [ABSTRACT FROM AUTHOR]

Background: Spontaneous kidney rupture could develop in the course of posterior urethral valve (PUV), the most common cause of outflow urinary tract obstruction in male infants. However, urinary extravasation is a rare complication among this group of children. Case Presentation: Our case report presents diagnostic difficulties connected with spontaneous kidney rupture due to PUV in a 6 week-old infant. Due to not equivocal images, thundery course of disease and rapid deterioration in the infant's condition, the patient required an urgent laparatomy. Conclusion: This case showed that the investigation of renal abnormalities during early neonatal period, is very important specifically in PUV that can lead to kidney rupture. [ABSTRACT FROM AUTHOR]

Spontaneous renal hemorrhage, known as Wunderlich syndrome, is a rare clinical condition. The most common cause is a tumor - benign or malignant. Other causes are: rupture of a renal cyst, vasculitis, hydronephrosis, pre-eclampsia, and kidney infections. Although rare, this syndrome may cause life-threatening hemorrhagic shock - it requires prompt diagnosis and treatment. Radiologic imaging plays an essential role in the diagnosis, although often misleading and insecure about the underlying entity. We report a case of Wunderlich syndrome caused by a renal cell carcinoma in a patient on anticoagulant treatment. A short review based on the literature is also presented. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 46-year-old man who was referred to hospital after vomiting and sudden onset of severe right flank pain. The patient was on chronic haemodialysis for 8 years due to end-stage renal failure. The meta-analysis used to the patient showed the sensitivity of computed tomography (CT) for the presence of retroperitoneal hemorrhage and underlying renal mass.

Abstract Background Ruptured renal neoplasms can be a catastrophic clinical presentation. Angiomyolipoma is the commonest renal tumor which presents in this fashion. Renal sarcomas are rare renal neoplasms. Renal leiomyosarcomas are the most common histological subtype of renal sarcomas, accounting for approximately 50–60% of the reported cases. These tumors are usually peripherally located and appear to arise from either the renal capsule or smooth muscle tissue in the renal pelvic wall. Case presentation A 70 years old male, with hypertension and ischemic disease, developed acute left flank pain. The general physician evaluated this using ultrasound, which showed a solid left renal mass. Two weeks later, he presented in the emergency room in a state of shock with a palpable flank mass. CT scan of the abdomen showed a large heterogeneous mass lesion in the left perinephric space with minimal post contrast enhancement. Per-operatively, large retroperitoneal hematoma was found within Gerota's fascia along with spleen plastered to the upper limit of hematoma. Nephrectomy and splenectomy were performed. Postoperative course was uneventful and patient was discharged on the 10th post-operative day. Histopathological evaluation of the specimen showed high-grade leiomyosarcoma Conclusions Spontaneous rupture of renal neoplasm is a rare clinical presentation. Angiomyolipoma is the commonest cause of spontaneous rupture of the kidney. Presentation of a leimyosarcoma as a ruptured renal neoplasm has not been previously reported in the English literature.

Background: Ruptured renal neoplasms can be a catastrophic clinical presentation. Angiomyolipoma is the commonest renal tumor which presents in this fashion. Renal sarcomas are rare renal neoplasms. Renal leiomyosarcomas are the most common histological subtype of renal sarcomas, accounting for approximately 50-60% of the reported cases. These tumors are usually peripherally located and appear to arise from either the renal capsule or smooth muscle tissue in the renal pelvic wall. Case presentation: A 70 years old male, with hypertension and ischemic disease, developed acute left flank pain. The general physician evaluated this using ultrasound, which showed a solid left renal mass. Two weeks later, he presented in the emergency room in a state of shock with a palpable flank mass. CT scan of the abdomen showed a large heterogeneous mass lesion in the left perinephric space with minimal post contrast enhancement. Per-operatively, large retroperitoneal hematoma was found within Gerota's fascia along with spleen plastered to the upper limit of hematoma. Nephrectomy and splenectomy were performed. Postoperative course was uneventful and patient was discharged on the 10th post-operative day. Histopathological evaluation of the specimen showed high-grade leiomyosarcoma Conclusions: Spontaneous rupture of renal neoplasm is a rare clinical presentation. Angiomyolipoma is the commonest cause of spontaneous rupture of the kidney. Presentation of a leimyosarcoma as a ruptured renal neoplasm has not been previously reported in the English literature. [ABSTRACT FROM AUTHOR]

Abstract: Background: Complications of extracorporeal shockwave lithotripsy (ESWL) occur in a small number of patients, although serious injury is rare. Objective: To report the serious complication of kidney rupture during ESWL. Case Report: A 65-year-old man was transferred to the Emergency Department (ED) with right flank pain. He had undergone ESWL for the right renal stone at a regional hospital 2 days earlier. Flank pain developed immediately after ESWL and was not spontaneously relieved. Computed tomography scan performed at the regional hospital showed an extensive right perinephric hematoma. When the patient arrived at the ED, his vital signs were unstable but were stabilized with fluid resuscitation and transfusion. Conservative care with no nephrectomy was chosen because there was no evidence of active bleeding on Doppler ultrasound examination. He was uneventfully discharged on the 31st hospital day without further complications. Conclusion: Although it is rare, patients may present with kidney rupture or hypotension after ESWL. [Copyright &y& Elsevier]