Ann Rehabil Med.  2013 Aug;37(4):595-600. 10.5535/arm.2013.37.4.595.

Spontaneous Perirenal Hemorrhage in Cauda Equina Syndrome: A Case Report

• Seok H
• Kim SH
• Choi WH
• Ko YJ

• KMID: 2266620
• DOI: http://doi.org/10.5535/arm.2013.37.4.595

Abstract

Neurogenic bladder is a common cause of acute pyelonephritis (APN) in cauda equina syndrome (CES). Perirenal hemorrhage, a rare complication of APN, can be a life-threatening condition. To our knowledge, there is no previous report of perirenal hemorrhage as a complication of APN in CES. A 57-year-old male, diagnosed with CES, due to a L3 burst fracture 3 months earlier, was presented with fever and chills. His diagnosis was APN due to neurogenic bladder. After treatment for APN, he was transferred to the department of rehabilitation medicine for management of his CES. Because of large post-voiding residual urine volumes, he performed self-catheterization after voiding. However, he presented again with fever and chills, and recurrent APN was diagnosed. On the third day of antibiotic treatment, he had acute abdominal pains and hypovolemic shock. Abdominal computed tomography and angiography showed left APN and a perirenal hematoma with left renal capsular artery bleeding. After embolization of the left renal capsular artery, no further active bleeding occurred. Because APN due to neurogenic bladder can lead to critical complications, such as perirenal hemorrhage, the physician should pay attention to the early diagnosis and treatment of urinary tract infection and the management of neurogenic bladder after CES.

Keyword

Acute pyelonephritis; Cauda equina syndrome; Perirenal hemorrhage

MeSH Terms

Abdominal Pain
Angiography
Arteries
Cauda Equina
Chills
Early Diagnosis
Fever
Hematoma
Hemorrhage
Humans
Male
Polyradiculopathy
Pyelonephritis
Shock
Urinary Bladder, Neurogenic
Urinary Tract Infections

Figure

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  Fig. 1 Initial T2-weighted magnetic resonance imaging scans show (A) burst fracture at L3 vertebral body and (B) retro-pulsed bony fragments into spinal canal. (C) Postoperation X-ray demonstrates posterior fixation state in L1-4.

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  Fig. 2 Contrast enhanced abdominal computerized tomography shows (A) multiple hypoattenuation of left kidney parenchyme (asterisk) and hypoattenuated fluid collection with density of blood in the perinephric space (arrow), (B) active extravasation of contrast media at the left renal capsular artery (arrow), and (C) hypoattenuated fluid collection with contrast leakage in lower left quadrant pelvic cavity (arrow).

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  Fig. 3 Selective left renal angiography shows suspicious contrast leakage of left renal capsular artery (A, arrow) and no more contrast leakage after renal capsular artery embolization with microcoils (B, arrow). Follow-up abdominal computerized tomography shows no visualization of active bleeding and embolization state with microcoils in left renal capsular artery (C, arrow).

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