Magalhães L. et al., 2019: Clinical use of renal point-of-care ultrasound after extracorporeal shock wave lithotripsy
Magalhães L, Nogué R.
Hospital da Luz - Arrábida, Praceta de Henrique Moreira 150, 4400-346, Vila Nova de Gaia, Portugal.
Universitat de Lleida, Plaça de Víctor Siurana, 1, 25003, Lleida, Spain.
Extracorporeal shock wave lithotripsy is widely used to treat symptomatic nephrolithiasis. Complications of this procedure can occur and point-of-care ultrasound can help to diagnose and manage some of these cases.
A 61-year-old man was admitted to the hospital with intense right lumbar pain 24 h after being submitted to a extracorporeal shock wave lithotripsy. Bedside ultrasound showed a hyperechoic subcapsular lesion along the right kidney. This finding, along with the clinical examination, suggested the diagnosis of subcapsular renal hematoma. The patient was managed conservatively with clinical and ultrasound reassessments.
This case shows the use of bedside ultrasound to diagnose a subcapsular renal hematoma as a complication of extracorporeal shock wave lithotripsy. However, the sensitivity is low and other image methods can be necessary to make the diagnosis.
Ultrasound J. 2019 Sep 30;11(1):25. doi: 10.1186/s13089-019-0141-8. FREE ARTICLE
This article is a case report of a patient who developed subcapsular hematoma after a session of SWL. The bottom-line is that bedside ultrasonography is helpful for the rapid diagnosis of this complication.
The patient presented with typical clinical symptomatology for a renal bleeding. The immediately appearing intensive pain after SWL always should raise the suspicion of hematoma. The history of hypertension needs attention because it is a risk factor for subcapsular hematoma. Even in case of well controlled blood pressure the vessels commonly are fragile. For this reason, SWL must be carried out in a careful way in terms of power level and total number of shockwaves.
Although the authors claim that the patient was hemodynamically stable, a blood pressure at 98/50 and heart rate of 110 are strongly suggesting bleeding complication. Nevertheless, it is my own experience that the vast majority of patients with subcapsular hematoma can be treated conservatively and in my own unit no patient with this complication has required surgical intervention during more than 30 years with more than 25 000 treatments.