Subepithelial pelvic hematoma of the kidney clinically mimicking cancer: Report of six cases and review of the literature

Objectives. Renal pelvic subepithelial hematoma is a rare but significant c linical mimic of neoplasm. Investigation and treatment of this diagnostic p roblem are uncertain. Methods. We add 6 patients with this entity to the 15 previously published cases. All 6 were clinically suspected of having cancer, and 5 underwent ne phrectomy. Results. The most common clinical findings are gross hematuria (19 of 21 ca ses) and acute onset of flank pain (15 of 21 cases). Intravenous urogram us ually reveals a filling defect at the ureteropelvic junction. Pathologic fi ndings include massive subepithelial and peripelvic hemorrhage, hydronephro sis, cortical infarcts, and renomegaly. Two of our patients have previously undescribed clinical associations, including one who was 2 weeks postpartu m and another with ureteropelvic junction obstruction. In addition, our pat ient with obstruction is the first with subepithelial hematoma to be treate d successfully with pyeloplasty. Conclusions. Subepithelial pelvic hematoma may be effectively treated with pyeloplasty or partial nephrectomy if distinguished from cancer preoperativ ely. Awareness of this rare entity may allow preoperative identification, b ut this has not been possible to date. (C) 1999, Elsevier Science Inc. All rights reserved.