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THEODORICO F. DA
COSTA NETO, JUAN M. RENTERIA, G. DI BIASE FILHO
Urology, Ipanema General Hospital, Rio de Janeiro, RJ, Brazil
Renal hemangioma is a relatively rare benign tumor, seldom diagnosed as
a cause of hematuria.
Case report: A female 40-year old patient
presented with continuous gross hematuria, anemia and episodic right lumbar
pain, with onset about 3 months previously. The patient underwent multiple
blood transfusions during her hospital stay and extensive imaging propedeutics
was performed. Semi-rigid ureterorenoscopy evidenced a bleeding focus
in the upper calix of the right kidney, with endoscopic treatment being
The patient underwent right upper pole nephrectomy and presented a favorable
outcome. Histopathological analysis of the surgical specimen showed that
it was a renal hemangioma.
Comments: Imaging methods usually employed
for diagnostic investigation of hematuria do not have good sensitivity
for renal hemangioma. However, they are important to exclude the most
frequent differential diagnoses. The ureterorenoscopy is the diagnostic
method of choice and endoscopic treatment can be feasible when the lesion
is accessible and electrocautery or laser are available. We emphasize
the open surgical treatment as a therapeutic option upon failure of less
words: kidney; hemangioma; hematuria
Int Braz J Urol. 2004; 30: 216-8
hemangioma is a relatively rare benign tumor, seldom diagnosed as a cause
of hematuria. Approximately 200 cases were reported since this condition
was first described by Virchow in 1867 (1). This tumor can be classified
as cavernous or capillary and the majority of lesions have a diameter
of less than 1 cm. It affects most frequently young adults and there is
no preference for gender.
Clinical presentation is characterized by
hematuria ranging from intermittent microscopic hemorrhage to abundant,
continuous bleeding, with hemodynamic repercussion.
We report one case of gross hematuria due
to renal hemangioma emphasizing clinical presentation, imaging diagnosis
and the treatment prescribed.
40-year old patient, complained of episodic gross hematuria with onset
around 4 years previously, which became continuous and associated with
episodic right lumbar pain in the past 3 months.
On the physical examination, gross hematuria
and anemia were evident. The patient underwent an ultrasonography of the
urinary tract, excretory urography and abdominal and pelvic computerized
tomography that did not evidence significant alterations. The semi-rigid
ureterorenoscopy showed a bleeding focus in the upper calix of the right
kidney, with endoscopic treatment being impossible due to difficulty of
access. Renal arteriography was performed, showing no alteration (Figure-1).
The patient maintained active bleeding, leading to persistent anemia and
requiring multiple blood transfusions during hospitalization. Renal arteriography
was unable to evidence the bleeding focus. However, considering its previous
location on semi-rigid ureterorenoscopy, an option was made towards selective
embolization of the right kidney upper pole (Figure-2).
Since there was no hematuria remission following
arterial embolization, the patient underwent a right upper pole nephrectomy
(Figure-3), presenting a favorable outcome, without hematuria within a
6-month follow-up. Histopathological analysis revealed renal hemangioma.
hemangioma is seldom diagnosed as a cause of hematuria. Imaging examinations
usually are not helpful for diagnosing hemangioma, though they are important
in order to exclude more frequent causes of hematuria.
The differential diagnosis of renal hemangioma
must include papillary necrosis, ectopic papilla, hemorrhagic papillitis
and urothelial carcinoma, among others (2).
Currently, the flexible ureterorenoscopy
is the method of choice for diagnosing this kind of lesion (3). When available,
the electrocautery or laser constitutes also the treatment of choice,
if the lesion is accessible. However, in the absence of such facilities,
open surgery is indicated in cases of persistent bleeding.
- Daneshmand S, Huffman JL: Endoscopic management of renal hemangioma.
J Urol. 2002; 167: 488-9.
- Viguier JL, Abbar M, Gelet A, Bouvier R, Martin X, Marechal JM, et
al.: The contribution of endoscopy in the diagnosis of unilateral hematuria
of renal origin and pseudotumors of the upper urinary tract. Prog Urol.
1994; 4: 219-27.
- Tawfiek ER, Bagley DH: Ureteroscopic evaluation and treatment of
chronic unilateral hematuria. J Urol. 1998; 160: 700-2.
Received: November 25, 2003
Accepted after revision: January 28, 2004
Dr. Juan Miguel Renteria
Hospital Geral de Ipanema
Rua Antônio Parreiras, 67 / 69
Rio de Janeiro, RJ, 22411–020, Brazil
Fax: + 55 21 3111-2362