A 50yo female with a past history of bipolar disorder, on lithium, referred to ED from outpatient clinic due to precipitous Hb drop. Hb in the 60s (from baseline of 100).

Two days prior she had undergone renal biopsy for assessment of declining renal function.

CT Case 030 01
CT Case 030 02

Describe and interpret the CT images


This non-contrast CT shows hyperdense material in both the left posterior perirenal and pararenal spaces.

Given the clinical history, this is in keeping with perirenal and pararenal haematoma. There is no renal laceration seen.

CT Case 030 01 label
CT Case 030 02 label

This patient went on to have a CT angiogram, describe this image

CT Case 030 03

There is no arterial blush demonstrated to suggest an active arterial bleed.

There is no abnormal parenchyma vascularity or early venous enhancement in the arterial phase to suggest an arterio-venous fistula.

CT Case 030 03 label


Perirenal haematoma is one of the known complications following renal biopsy, clinically significant bleeds occur in 6% of cases. Other possible complications of biopsy include gross haematuria and arterio-venous fistula formation.

This patient was managed with 2 x PRBC transfusion.

Renal biopsy confirmed advanced chronic tubulointerstitial nephritis, most likely due to her long-term lithium use.


Dr Leon Lam FRANZCR MBBS BSci(Med). Clinical Radiologist and Senior Staff Specialist at Liverpool Hospital, Sydney

Sydney-based Emergency Physician (MBBS, FACEM) working at Liverpool Hospital. Passionate about education, trainees and travel. Special interests include radiology, orthopaedics and trauma. Creator of the Sydney Emergency XRay interpretation day (SEXI).

Provisional fellow in emergency radiology, Liverpool hospital, Sydney. Other areas of interest include paediatric and cardiac imaging.

Emergency Medicine Education Fellow at Liverpool Hospital NSW. MBBS (Hons) Monash University. Interests in indigenous health and medical education. When not in the emergency department, can most likely be found running up some mountain training for the next ultramarathon.

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