Fig. 3

A 63-year-old male patient with comorbidities suffered from syncope, flank pain and tenderness, with a 3 g/dl haemoglobin drop 6 h after ESWL treatment of right-sided lithiasis of the renal pelvis (arrowhead) and distal ureter (thin arrows) at preoperative unenhanced MDCT (A). After bedside ultrasound (not shown) detected an inhomogeneously echoic renal collection, urgent multiphase contrast-enhanced MDCT including multiplanar reformatted images (B, C, D) confirmed a hyperattenuating (55–60 HU) acute subcapsular renal haematoma (*) extending towards the diaphragmatic crus. The ventrally displaced right kidney appeared functioning with residual lithiasis and a focal parenchymal laceration (thin arrow in D) in the nephrographic acquisition. Atelectasis and moderate pleural effusion were seen at the ipsilateral lung base. Hydronephrosis, active bleeding and urine extravasation were excluded. Conservative treatment including blood transfusions achieved clinical improvement and stabilisation of the haematocrit. Follow-up MDCT 3 weeks later (E) showed haematoma (*) with decreased attenuation (35–40 HU) indicating initial liquefaction. One year later, unenhanced MDCT during another episode of renal colic demonstrated resolved haematoma (arrows in F)