A 69-year-old male patient presented to our emergency department with sudden left-sided flank pain associated with macroscopic haematuria. There was no history of trauma. Haemoglobin was 11.4 g/dL and abdominal multidetector computed tomography demonstrated a left simple renal cyst with a thin line of blood collection (Fig. 1A). At 48 hours, a second episode of massive macroscopic haematuria occurred. Haemoglobin has dropped to 9.3 g/dL and multidetector computed tomography demonstrated an increased level of blood collection into the left renal cyst (Fig. 1B). The patient underwent selective (Fig. 2A) and superselective (Fig. 2B) left renal artery angiography that showed two microspots of blood extravasation. Endovascular embolization was performed. Final angiographic control demonstrated occlusion of bleeding extravasation (Fig. 2C). At 12 hours, macroscopic haematuria had resolved and haemoglobin data showed an upward trend to 11.0 g/dL. Imaging follow-up at 72 hours (Fig. 3A) and 1 month (Fig. 3B) demonstrated left renal cyst reduction in size.
Simple renal cysts are benign and usually asymptomatic, so no treatment is required. When they are symptomatic, as with haemorrhage, treatment might be necessary [1]. Only three cases of transcatheter arterial embolization of symptomatic patients with haemorrhagic renal cysts are described in the literature [2,3].
As demonstrated by our clinical case, transcatheter arterial embolization of renal intracystic active bleeding as definitive treatment (like other body regions) may have advantages over surgery of a less invasive procedure, the possibility to progress from diagnosis to treatment in the same session, and the possibility of minor loss of normal renal parenchyma [2-4]. The patient provided written informed consent for publication of the research details and clinical images.
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