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Hemorrhage from lumbar artery following percutaneous renal biopsy.

Devi BV, Lakshmi BS, Supraja C, Vanajakshmma V, Ram R, Rajasekhar D, Lakshmi AY, Sivakumar V - Indian J Nephrol (2015 Jul-Aug)

Bottom Line: Within minutes, the radiologist noticed an echogenic band around left kidney and in the muscular planes.Computerized tomography revealed focal active contrast extravasation from arcuate or interlobular artery in lower pole of left kidney and lumbar artery at third lumbar vertebra.The bleeding vessel was occluded with gelfoam.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India.

ABSTRACT
We present a 58-year-old lady who underwent ultrasound-guided renal biopsy for suspected acute glomerulonephritis. Within minutes, the radiologist noticed an echogenic band around left kidney and in the muscular planes. Computerized tomography revealed focal active contrast extravasation from arcuate or interlobular artery in lower pole of left kidney and lumbar artery at third lumbar vertebra. The bleeding vessel was occluded with gelfoam.

No MeSH data available.


Related in: MedlinePlus

2.25F micro catheter introduced into lumbar artery
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Figure 5: 2.25F micro catheter introduced into lumbar artery

Mentions: Patient was subjected to a renal biopsy with a 16 gauge automated spring-loaded biopsy gun with length for sample notch being 1.6 cm and a possible penetration depth of 22 mm (Bard Biopty Systems, USA). It was done under real-time ultrasound guidance. The left kidney was biopsied. After first specimen, the check ultrasound was normal. After second pass, the patient complained of pain from the biopsy site to the left flank and anterior abdomen. The radiologist noticed the appearance of an echogenic band around left kidney and in the muscular planes. A computerized tomography scan of abdomen revealed left perinephric collection of 1200 ml and heterogenous collection in left lumbar region [Supplementary Figure 1]. Angiogram revealed a focal active contrast extravasation from arcuate or interlobular artery in lower pole of left kidney and from lumbar artery at third lumbar vertebra [Supplementary Figure 2]. Her blood pressure fell to 80/60 mmHg from the pre-biopsy reading of 140/100 mmHg, and the hemoglobin dropped to 8.1 g/dl. She was started on whole blood transfusion and inotropes. Within 1 h aortic, renal and lumbar artery angiogram was performed. Right femoral artery was cannulated with a Cordis 6.0F femoral sheath, into which a Judkin's diagnostic catheter 5.0F was passed. Into this catheter, floppy percutaneous transluminal coronary angioplasty guidewire, 0.014 inch in diameter and 300 cm in length was passed to reach the bleeding site in the lumbar artery. The bleeding site was approximately 10.5 cm away from the vertebral column [Figure 1 and Supplementary Figure 3]. Over this guidewire, a micro catheter, 2.25F and 130 cm in length (AsahiIntecc) was passed [Supplementary Figure 4]. Into this micro catheter, Gelfoam was injected so as to occlude the bleeding site [Supplementary Figure 5]. The blood pressure improved to 130/80 mm Hg immediately after the procedure. She did not require any blood transfusions. The hematoma remained palpable for 5 weeks. The light and immunofluorescence microscopy confirmed the diagnosis as postinfectious glomerulonephritis.


Hemorrhage from lumbar artery following percutaneous renal biopsy.

Devi BV, Lakshmi BS, Supraja C, Vanajakshmma V, Ram R, Rajasekhar D, Lakshmi AY, Sivakumar V - Indian J Nephrol (2015 Jul-Aug)

2.25F micro catheter introduced into lumbar artery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495478&req=5

Figure 5: 2.25F micro catheter introduced into lumbar artery
Mentions: Patient was subjected to a renal biopsy with a 16 gauge automated spring-loaded biopsy gun with length for sample notch being 1.6 cm and a possible penetration depth of 22 mm (Bard Biopty Systems, USA). It was done under real-time ultrasound guidance. The left kidney was biopsied. After first specimen, the check ultrasound was normal. After second pass, the patient complained of pain from the biopsy site to the left flank and anterior abdomen. The radiologist noticed the appearance of an echogenic band around left kidney and in the muscular planes. A computerized tomography scan of abdomen revealed left perinephric collection of 1200 ml and heterogenous collection in left lumbar region [Supplementary Figure 1]. Angiogram revealed a focal active contrast extravasation from arcuate or interlobular artery in lower pole of left kidney and from lumbar artery at third lumbar vertebra [Supplementary Figure 2]. Her blood pressure fell to 80/60 mmHg from the pre-biopsy reading of 140/100 mmHg, and the hemoglobin dropped to 8.1 g/dl. She was started on whole blood transfusion and inotropes. Within 1 h aortic, renal and lumbar artery angiogram was performed. Right femoral artery was cannulated with a Cordis 6.0F femoral sheath, into which a Judkin's diagnostic catheter 5.0F was passed. Into this catheter, floppy percutaneous transluminal coronary angioplasty guidewire, 0.014 inch in diameter and 300 cm in length was passed to reach the bleeding site in the lumbar artery. The bleeding site was approximately 10.5 cm away from the vertebral column [Figure 1 and Supplementary Figure 3]. Over this guidewire, a micro catheter, 2.25F and 130 cm in length (AsahiIntecc) was passed [Supplementary Figure 4]. Into this micro catheter, Gelfoam was injected so as to occlude the bleeding site [Supplementary Figure 5]. The blood pressure improved to 130/80 mm Hg immediately after the procedure. She did not require any blood transfusions. The hematoma remained palpable for 5 weeks. The light and immunofluorescence microscopy confirmed the diagnosis as postinfectious glomerulonephritis.

Bottom Line: Within minutes, the radiologist noticed an echogenic band around left kidney and in the muscular planes.Computerized tomography revealed focal active contrast extravasation from arcuate or interlobular artery in lower pole of left kidney and lumbar artery at third lumbar vertebra.The bleeding vessel was occluded with gelfoam.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India.

ABSTRACT
We present a 58-year-old lady who underwent ultrasound-guided renal biopsy for suspected acute glomerulonephritis. Within minutes, the radiologist noticed an echogenic band around left kidney and in the muscular planes. Computerized tomography revealed focal active contrast extravasation from arcuate or interlobular artery in lower pole of left kidney and lumbar artery at third lumbar vertebra. The bleeding vessel was occluded with gelfoam.

No MeSH data available.


Related in: MedlinePlus