Description

A 59-year-old male patient with a previous diagnosis of prostate cancer presented to the emergency department with left-sided abdominal pain. Physical examination was unremarkable except for high blood pressure (190/115 mm Hg). There was no history of hypertension before admission. The patient was afebrile, he had no respiratory distress. Abdomen was soft and no rigidity or mass was present with palpation. The patient underwent abdominal CT scan which revealed left subcapsular renal haematoma. The thickest part of the subcapsular haematoma measured 31 mm. A reduction in contrast uptake in the parenchymal portion of the affected kidney due to compression effect of haematoma was noted in CT images (figure 1A–C).

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Figure 1

Intravenous contrast-enhanced CT (A) axial, (B) coronal reformatted and (C) sagittal reformatted images. Subcapsular haematoma encasing perirenal region of left kidney and reduced parenchymal contrast uptake secondary to compression by the surrounding haematoma.

Page kidney is a rare condition resulting in hypertension secondary to renal compression by a subcapsular haematoma, tumour or cyst. External compression of the renal parenchyma results in hypoperfusion and activation of the renin-angiotensin-aldesterone axis.1 Page kidneys occurring in association with traumatic events such as motor vehicle accidents, sport injuries and renal interventions have been reported in the literature.2 Recently, Smyth et al2 reported non-trauma associated cases occurred due to native kidney biopsies, ruptured renal cyst, hypernephroma or renovascular diseases. Our patient only had a history of prostate surgery 2 years ago and no recent history of trauma. In the past, definitive management of Page kidney was radical nephrectomy or surgery. However, most recent reports present a trend towards minimal invasive procedures such as percutaneus drainage of haematoma, endoscopic interventions and other preventive techniques.3 The age of the haematoma is important for the choice of treatment. Haematomas less than 3 weeks old usually resolve spontaneously. But percutaneous drainage is usually unsuccessful and nephrectomy or capsulectomy are necessary in the cases of organised late haematomas.1 In our case, arterial hypertension is successfully taken under control with ACE inhibitor and diuretic treatment. Ultrasound follow-up revealed decrease in the size of haematoma. No further interventions or surgery were needed. Also Page kidney is a rare condition, it should be considered in the differential diagnosis of secondary arterial hypertension. Early diagnosis allows a chance to medical therapy.