The association of renal cancer with renal hematoma is very rare.
Renal hematoma show contrast pattern that significantly differs from the
pattern in renal cancer. The contrast enhancement of the renal cancer depends
on the neovascularization of the tumor.
We reported a 74-years-old male patient who manifested with left flank
pain and macroscopic hematuria. In February 2013, on CT scan he was diagnosed
renal stone and underwent ESWL. The second CT scan, performed for persistent
flank pain and hematuria, revealed inflammatory changes and hydronephrosis of
the left kidney and DJ-ureteral stent was placed. The control Triplex ultrasound
investigation at the backgound of persistent hematuria revealed formation
engaging the lower pole of the left kidney and with Doppler Ultrasound- thrombosis
of the left renal vein. The contrast enhanced ultrasound investigation (CEUS) revealed
renal hematoma and tumor formation. MRT detected a tumor of left kidney with
possible engagement of the left renal vein. The patient underwent nephrectomy
of the left kidney and the described formation was verified transitional-cell
renal cancer.
The presented case represents an interesting challenge for the clinicians and
for the imaging methods due to the difficult clinical and imaging diagnosis.
