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A case of renal subcapsular hematoma caused by an accident injection from renal capsular artery.

Qu XL, Hu HY - Chin. Med. J. (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.

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To exclude coronary heart disease and renal artery stenosis, coronary angiography (CAG) and renal artery angiography were performed simultaneously through the right radial artery by 5 Fr Terumo Optitorque TIG catheter, the results showed that both coronary and renal arteries were normal... After CAG, multifunctional catheter was also used for renal artery angiography... But she complained of a gradually aggravated pain in the right waist immediately after the right renal artery angiography, and blood pressure was decreased to 90/40 mmHg half an hour later... The abdominal ultrasonography indicated a perirenal hematoma around the right kidney [Figure 1a]... We finally found that the right renal artery angiography was just slightly emerged by an accident injection from renal capsular artery above the right renal artery [Figure 1b]... The most common causes of RSH are guide wire-induced perforation and accident entry of super-slip wire... Transradial renal arteriography reduces complications to some extent, especially pseudoaneurysm and retroperitoneal hematoma, which are related to the elder (≥60 years), female gender, hypertension, thrombocytopenia, large-bore catheter use, operator inexperience, poor groin compression after sheath removal, high puncture site, abnormal vessel or graft, peripheral vascular disease and anticoagulant-thrombolytic therapy... Here, we reported a rare case that an accident injection from renal capsular artery resulted in RSH, which was associated with the inappropriate catheter use... To avoid the similar accidents, enforced injection should not be performed until the target artery is confirmed by a slight injection ahead, and pigtail catheter should be used for unselective renal angiography.

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(a) The ultrasonography indicated a perirenal hematoma around the right kidney; (b) The right renal artery angiography was just slightly emerged by an accident injection from renal capsular artery above the right renal artery.
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Figure 1: (a) The ultrasonography indicated a perirenal hematoma around the right kidney; (b) The right renal artery angiography was just slightly emerged by an accident injection from renal capsular artery above the right renal artery.

Mentions: To the Editor: A 49-year-old woman was admitted with hypertension and diabetes. Electrocardiogram demonstrated inverted T waves in V1–6. Blood pressure was 180/110 mmHg. Total cholesterol was 4.82 mmol/L, high-density lipoprotein-cholesterol was 1.12 mmol/L, and low-density lipoprotein-cholesterol was 3.08 mmol/L. To exclude coronary heart disease and renal artery stenosis, coronary angiography (CAG) and renal artery angiography were performed simultaneously through the right radial artery by 5 Fr Terumo Optitorque TIG catheter, the results showed that both coronary and renal arteries were normal. After CAG, multifunctional catheter was also used for renal artery angiography. But she complained of a gradually aggravated pain in the right waist immediately after the right renal artery angiography, and blood pressure was decreased to 90/40 mmHg half an hour later. The abdominal ultrasonography indicated a perirenal hematoma around the right kidney [Figure 1a]. We finally found that the right renal artery angiography was just slightly emerged by an accident injection from renal capsular artery above the right renal artery [Figure 1b]. Then an appropriate dosage of protamine was given by venous injection, vasopressor agents were used at the early stage, and the condition become stable after transfusion of totally 1600 ml red blood cells. She was discharged 3 weeks later.


A case of renal subcapsular hematoma caused by an accident injection from renal capsular artery.

Qu XL, Hu HY - Chin. Med. J. (2015)

(a) The ultrasonography indicated a perirenal hematoma around the right kidney; (b) The right renal artery angiography was just slightly emerged by an accident injection from renal capsular artery above the right renal artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834791&req=5

Figure 1: (a) The ultrasonography indicated a perirenal hematoma around the right kidney; (b) The right renal artery angiography was just slightly emerged by an accident injection from renal capsular artery above the right renal artery.
Mentions: To the Editor: A 49-year-old woman was admitted with hypertension and diabetes. Electrocardiogram demonstrated inverted T waves in V1–6. Blood pressure was 180/110 mmHg. Total cholesterol was 4.82 mmol/L, high-density lipoprotein-cholesterol was 1.12 mmol/L, and low-density lipoprotein-cholesterol was 3.08 mmol/L. To exclude coronary heart disease and renal artery stenosis, coronary angiography (CAG) and renal artery angiography were performed simultaneously through the right radial artery by 5 Fr Terumo Optitorque TIG catheter, the results showed that both coronary and renal arteries were normal. After CAG, multifunctional catheter was also used for renal artery angiography. But she complained of a gradually aggravated pain in the right waist immediately after the right renal artery angiography, and blood pressure was decreased to 90/40 mmHg half an hour later. The abdominal ultrasonography indicated a perirenal hematoma around the right kidney [Figure 1a]. We finally found that the right renal artery angiography was just slightly emerged by an accident injection from renal capsular artery above the right renal artery [Figure 1b]. Then an appropriate dosage of protamine was given by venous injection, vasopressor agents were used at the early stage, and the condition become stable after transfusion of totally 1600 ml red blood cells. She was discharged 3 weeks later.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

To exclude coronary heart disease and renal artery stenosis, coronary angiography (CAG) and renal artery angiography were performed simultaneously through the right radial artery by 5 Fr Terumo Optitorque TIG catheter, the results showed that both coronary and renal arteries were normal... After CAG, multifunctional catheter was also used for renal artery angiography... But she complained of a gradually aggravated pain in the right waist immediately after the right renal artery angiography, and blood pressure was decreased to 90/40 mmHg half an hour later... The abdominal ultrasonography indicated a perirenal hematoma around the right kidney [Figure 1a]... We finally found that the right renal artery angiography was just slightly emerged by an accident injection from renal capsular artery above the right renal artery [Figure 1b]... The most common causes of RSH are guide wire-induced perforation and accident entry of super-slip wire... Transradial renal arteriography reduces complications to some extent, especially pseudoaneurysm and retroperitoneal hematoma, which are related to the elder (≥60 years), female gender, hypertension, thrombocytopenia, large-bore catheter use, operator inexperience, poor groin compression after sheath removal, high puncture site, abnormal vessel or graft, peripheral vascular disease and anticoagulant-thrombolytic therapy... Here, we reported a rare case that an accident injection from renal capsular artery resulted in RSH, which was associated with the inappropriate catheter use... To avoid the similar accidents, enforced injection should not be performed until the target artery is confirmed by a slight injection ahead, and pigtail catheter should be used for unselective renal angiography.

Show MeSH
Related in: MedlinePlus