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Lumbar artery bleeding as a complication of percutaneous nephrostomy in a patient with coagulopathy

Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, NT, Hong Kong

View larger version (59K): [in a new window]   Figure 1. (a) CT abdomen examination 4 days following percutaneous nephrostomy. There was a huge retroperitoneal haematoma in the left posterior pararenal space. The left kidney was displaced anteromedially and the perirenal space was clear. The pigtail catheter was dislodged and was within the haematoma. (b) Contrast medium extravasation (arrow) was noted within the haematoma. There were prominent vessels (arrowhead) just posterior to the area of contrast medium extravasation. CT appearances raised the possibility of bleeding from the lumbar artery.

View larger version (168K): [in a new window]   Figure 2. Flush aortogram revealed active contrast medium leakage from the first left lumbar artery (arrow). The aorta was mildly displaced to the right side owing to the presence of a huge haematoma.

View larger version (154K): [in a new window]   Figure 3. Selective arteriogram of the left first lumbar artery demonstrated active bleeding. The site of bleeding was below the percutaneous nephrostomy tract.

View larger version (149K): [in a new window]   Figure 4. Selective arteriogram of the left first lumbar artery following embolisation. No further contrast medium leakage can be seen.