Spontaneous Perinephric Hemorrhage

Renal cell carcinoma (RCC) is the fourth most common genitourinary malignancy in the United States, with an estimated 36,000 new cases expected in 2005 (Jemal et al. 2005). In contrast to years past, the majority of cases are now diagnosed incidentally due to the widespread availability and performance of abdominal imaging. While presentation with the classic triad of flank pain, gross hematuria, and a palpable abdominal mass is now rare (Jayson and Sanders 1998), a small proportion of cases complicated by a spontaneous perinephric hemorrhage (SPH) will demonstrate one or all of these findings. It is difficult to estimate the true incidence of spontaneous tumor hemorrhage since SPH is not specific to RCC and most descriptions of SPH amount to case reports only. Nonetheless, this would appear to be an uncommon mode of presentation for RCC. Neovas-cularity and propensity for necrosis are possible explanations for tumor rupture and hemorrhage (Hora et al. 2004).

13.2 Spontaneous Perinephric Hemorrhage 143

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