To describe multidetector computed tomography (MDCT) technique, role, and findings in diagnosing spontaneous renal haemorrhage (SRH), particularly in emergency conditions. To discuss major causes and cross-sectional imaging features of SRH, with regard to interventional radiology procedures.

Spontaneous renal hemorrhage (SRH) is an exceptional but potentially life-threatening urological emergency. The classical (Lenk’s) triad of symptoms including acute abdominal pain, palpable flank mass and hypovolemic shock is observed in severe SRH. Most usually, however, clinical manifestations are varied and nonspecific. Causes of SRH include (Fig. 1): Renal tumours (angiomyolipoma (fig. 02), renal cell carcinoma) Vascular diseases (polyarteritis nodosa, renal artery aneurysms, artero-venous fistulas) Renal infections Cystic kidney disease Coagulation disorders and anticoagulation therapy (fig. 03) Idiopathic SRH is diagnosed in approximately 7% of...

Multidetector Computed Tomography (MDCT) is recommended as the imaging modality of choice to assess SRH. Unenhanced scans are usually sufficient to detect fresh blood collections, which appear hyperdense (40 to 70 Hounsfield Units) (fig. 04). However, unless contraindicated a multiphasic contrast-enhanced acquisition is strongly recommended to better assess severity, anatomical extent and underlying cause An early acquisition (30 to 40 seconds delay) after intravenous contrast medium administration provides an arterial phase scan that is necessary to detect or rule out active contrast extravasation indicating ongoing...

Contrast-enhanced MDCT is the imaging modality of choice in the evaluation of SRH. Knowledge of imaging appearances characteristic of the possible underlying causes is necessary since precise diagnosis may alter therapeutic or surgical management. Renal artery embolization is an effective, versatile therapeutic tool in SRH management, that can be also successfully applied in reduce renal blood supply before total or partial nephrectomy.

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Alessandro Campari Diagnostic and Interventional Radiology School, University of Milan Department of Diagnostic and Interventional Radiology, San Paolo Hospital via A. di Rudinì, 8 ‐ 20142 Milan (Italy) [email protected] Massimo Tonolini Department of Radiology, Luigi Sacco Hospital via G.B. Grassi, 74 ‐ 20157 Milan (Italy) [email protected]