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Complications of renal interventions: a pictorial review of CT findings


A number of potential vascular and non-vascular complications can arise from surgical, extracorporeal shock wave lithotripsy, radiotherapy and radiological renal interventions, including percutaneous image-guided biopsy and drainage. Computed tomography scan is usually one of the first and most important diagnostic imaging examinations requested when a potential complication is suspected. There are a wide range of common and uncommon potential complications from renal interventions. An understanding of underlying risk factors is important to reduce potential complications from renal intervention. Radiologists play a crucial role in recognising and diagnosing post-renal intervention complications on computed tomography scans, which could significantly improve the patient’s prognosis.

Key points

  • There are a wide range of complications from renal interventions.

  • Knowledge of CT findings will enable the primary diagnosis of potential complications.

  • An understanding of underlying risk factors may reduce complications from renal interventions.

  • Early diagnosis of complications from renal intervention could improve the patient’s prognosis.


The incidence of common renal pathologies such as renal calculi and renal cell carcinoma has continuously increased over the past 50 years [1,2,3,4]. This has in part been attributed to the ubiquity of high-quality imaging such as ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI), leading to increased detection of smaller renal masses [5, 6] and of smaller renal calculi [2, 3].

The prevalence of renal calculi is estimated to be as high as 10–13% worldwide, increasing with age [2, 7]. Renal cell carcinoma makes up the majority (approximately 90%) of detected renal cancers [8] and has been increasing in incidence worldwide, with an age-standardised incidence rate of up to 16.7 per 100,000 [9].

The increased incidence of renal pathologies has significantly increased the number of renal interventions undertaken to diagnose and to treat renal pathologies. For example, the rates of intervention performed for urinary calculi have increased by approximately 17% in the past 20 years [10].

In addition, the increased detection of smaller and, often asymptomatic, renal pathologies have also led to the adoption of more conservative management options and to a progressive increase in a variety of more targeted and less invasive interventions [10, 11]. For example, a recent systematic review of data from six countries found that the use of extracorporeal shockwave lithotripsy and open surgery fell by 14.5% and 12%, respectively, whilst the use of ureteroscopy increased by more than 250% in the past two decades [10]. The use of nephron-sparing interventions such as partial nephrectomy and ablative techniques is also increasingly favoured over radical nephrectomies. An analysis of the National Cancer Database, recognised as the largest cancer registry in the world, showed that the proportion of patients receiving partial nephrectomy has almost doubled over approximately 10 years, from approximately 36.4% in 2004 to 61.2% in 2015 [12].

A wide range of interventions form part of the diagnostic and therapeutic pathway of renal diseases. These include renal procedures such as lithotripsy, radiological renal interventions such as image-guided core biopsies, as well as therapeutic interventions such as surgery, namely nephrectomy, and radiotherapy, whilst shown to have high rates of safety and efficacy, these interventions are also associated with some potential complications. The aim of this article is to familiarise the radiologist with the common and less common complications from various renal interventions. Risk factors that are more commonly associated with complications will also be summarised. This could help the radiologist to prevent, as well as to diagnose, complications from renal interventions.

Surgical complications

Nephrectomy and ablative therapy complications

Open and laparoscopic radical nephrectomy is the gold standard in the management of large renal masses [13]. For smaller lesions, nephron-sparing procedures such as partial nephrectomy or percutaneous therapies are increasingly favoured.

Early CT imaging is indicated to assess the clinically suspected complications of surgery and to enable early management. Two main complications following nephrectomy requiring CT imaging is haemorrhage and urinary leakage [4]. Post-operative haemorrhage may arise from an unsecured artery, or days to weeks later due to the rupture of a pseudoaneurysm of an intrarenal artery (Fig. 1). The presence of a post-operative perinephric haematoma can be demonstrated by CT, ultrasound or MR imaging; however, the site of active haemorrhage is best demonstrated on a CT angiography (CTA), or ultimately, diagnostic angiography (DSA) (Fig. 2) [14]. A multiphase study is recommended, including non-contrast, arterial and subsequent portal venous phase approximately a minute after injection of a contrast bolus [15]. Acute haematomas are typically hyperattenuating (40–60 Hounsfield units) relative to the renal parenchyma on unenhanced CT images [16]. Small subcapsular haematomas appear crescenteric when small and biconvex when large on CT [16]. Extravasation of contrast material, indicating active bleeding, was first described by Sivit et al. [17]. The extravasated contrast has a density close to the density of either the aorta or other major adjacent arteries and is typically surrounded by lower attenuation haematoma [18]. The presence of vascular extravasation of contrast enables the identification of the anatomic site of injury to inform emergent treatment to prevent a potentially life-threatening haemorrhage [19].

Fig. 1

Arterial phase CT image of a pseudoaneurysm (white arrow) post-laparoscopic partial nephrectomy of the lower pole of the left kidney

Fig. 2

a Arterial phase CT image of perinephric haematoma (white arrow) at the site of partial nephrectomy. The residual left kidney is indicated by the yellow arrow. b Active extravasation of contrast (white arrow) was confirmed on DSA

A study of 1800 cases of open and laparoscopic partial nephrectomies found that approximately 5% of patients suffer significant blood loss requiring transfusion, with no significant difference in blood transfusion rates between the open or laparoscopic approach [20]. Asymptomatic pseudoaneurysms have been detected on CT scans in approximately 15% of patients following partial nephrectomy in the early post-operative period [21]. These usually spontaneously resolved, but a small number, approximately 1% in a case series, have required selective arterial embolisation [22].

Urinary leakage has been reported in approximately 1% of patients following open or laparoscopic partial nephrectomy [22, 23]. It can occur from intra-operative injury to the renal pelvis, ureters or urinary bladder. This may be clinically suspected following flank pain, renal dysfunction or drainage of urine from a surgical drain. A urinoma may be detected as a perinephric collection on an ultrasound, CT or MRI scan, which may cause ureteric or vascular compression. The site of urinary leakage is most commonly demonstrated as contrast extravasation from the renal tracts or collecting system on a CT urogram study, performed approximately 10–15 min after intravenous administration of contrast (Fig. 3) [16].

Fig. 3

Delayed excretory phase CT image of contrast extravasation into a urinoma (white arrow) following left ureteric injury during a left partial nephrectomy. The yellow arrow demonstrates the site of active contrast extravasation from the left pelvi-ureteric junction, which was injured during the operation. A nephrostomy catheter (red arrow) was sited to decompress the collecting system and to facilitate urinary drainage. The patient developed persistent pelvi-ureteric junction obstruction and required a completion left nephrectomy

Intra-operative injuries to the adjacent structures can also occur post-renal surgery. Splenic injuries have been reported to occur in 4–13% of cases following left nephrectomy [24]. Pancreatic, liver and gastric injuries have also been reported following renal surgeries (Fig. 4) [25]. Bowel injury occurs in less than 1% of cases following laparoscopic surgery [26]. Rarely, pneumothoraces can be caused by diaphragmatic injury during dissection of the upper pole of the kidney.

Fig. 4

a Axial and (b) coronal images of pancreatic injury (white arrow) with a rim-enhancing fluid- and gas-containing collection (yellow arrow) following left nephrectomy for RCC

Ischaemic injury can also occur following prolonged clamping intra-operatively or due to renal artery manipulation leading to thrombosis or stenosis. Renal tract obstruction could also occur following direct ureteric injury or ischaemia leading to ureteric stenosis [4]. This could lead to renal tract obstruction and subsequent urinary leakage.

Urological complications following stone treatment

The surgical management of urinary tract stones has evolved from open surgery to a range of minimally invasive procedures. With the exception of complex staghorn calculi, a range of minimally invasive techniques have been employed by urologists to treat urinary tract calculi, including extracorporeal shock wave lithotripsy (ESWL), and ureteroscopy, flexible ureterorenoscopy and percutaneous nephrolithotomy (PCNL) [27]. The selection of each technique is influenced by the surgeon’s experience, the nature of the stone burden, stone location, anatomy of the urinary tract and patient preference.

ESWL is a common minimally invasive treatment for renal tract calculi [28], with relatively few complications. One of the most common complications is the formation of a perinephric or subcapsular haematoma, with an incidence of approximately 4% (Fig. 5) [29]. The risk of a renal haematoma post-ESWL is significantly increased with increasing patient age [29], use of a therapeutic dose of low molecular weight heparin and the presence of an untreated urinary tract infection [30]. The resultant compression of the kidney from the perinephric or subcapsular haematoma has been reported to cause systemic hypertension, also known as Page kidney [31]. Repeated ESWL has been reported to cause ureteric perforation (Fig. 6), renal atrophy and irreversible damage to renal function [32, 33].

Fig. 5

Coronal delayed excretory phase CT images of calyceal rupture and urinoma formation (white arrows) with perinephric extravasation of contrast in two patients. a Post-ESWL and (b) post-pyeloplasty

Fig. 6

Axial contrast-enhanced CT images of (a) perinephric haematoma (white arrow), and (b) subcapsular haematoma (white arrow) post-ESWL in two patients

Ureteroscopy has also been shown to be effective in treating renal tract calculi with low complication rates [27]. The most common minor intra-operative complications were mucosal abrasions and bleeding, accounting for approximately 60% of the cases [34]. The incidence of serious complications such as bleeding and perforation is low at approximately 1–3% [34, 35]. Extra-ureteric stone migration and ureteric avulsion are also very rare (< 1%) [34, 35].

PCNL has been shown to more effective in treating larger renal stones, with fewer retained stone fragments, but are associated with higher rates of complications such as fever, bleeding and renal scarring [36]. Post-procedural fever and bleeding have been reported to be as high as 10.5% and 7.8%, respectively [37]. Migration of residual stone fragments into the proximal ureter is rare and most fragments past spontaneously (Fig. 7) [38]. Injuries to the adjacent viscera such as bowel, liver, spleen and diaphragm are rare (< 1%) [39].

Fig. 7

Unenhanced CT image of migration of renal calculi (white arrows) into the left percutaneous nephrolithotomy tract and a small left perinephric urinoma post-PCNL of a left staghorn calculus. There is a inferior migration of the ureteric calculus within the left proximal ureter (yellow arrow). A right-sided ureteric stent is in situ (red arrow)

Percutaneous complications

Renal biopsy

More than half of renal cell carcinomas are now incidentally diagnosed [40]. Whilst the majority of incidentally detected renal masses are renal cell carcinomas, up to a fifth of incidentally detected renal masses are benign tumours [41]. There is a general consensus that the distinction of solid RCC from benign renal tumours such as renal oncocytoma and fat-poor angiomyolipomas, and of oncocytic tumours such as oncocytomas from chromophobe RCC, is not yet entirely possible or reproducible with imaging [42]. Despite advances in imaging techniques and algorithms, percutaneous image-guided renal biopsies are still needed to differentiate between benign and malignant renal tumours.

Current guidelines recommend targeted core biopsies of solid renal tumours to confirm or to exclude malignancy prior to treatment when the results may alter surgical management [43]. Core biopsy of cystic tumours, tumours originating in the collecting system or suspected urothelial cancer should not be performed [43]. Renal masses suspected of being haematologic, metastatic, inflammatory or infectious should also be biopsied to guide management, which is often very different from the RCC management pathway [44].

In addition, percutaneous renal biopsy is essential in the diagnosis of intrinsic renal disease [45]. Indications vary between nephrologists. These include the diagnosis of idiopathic nephritic and nephrotic syndromes, the diagnosis of focal primary lesions, the detection of acute or chronic renal allograft rejection and the evaluation of antirejection therapy [46, 47]. Non-nephrotic proteinuria and isolated glomerular haematuria are usually regarded as conditions in which biopsy is not indicated [47]. Image-guided renal biopsies are usually performed with ultrasound or CT guidance (Fig. 8). The use of percutaneous image-guided renal biopsies could also reduce the number of nephrectomies performed for benign renal masses and for indolent renal carcinomas [12, 48, 49]. The pre-operative diagnosis of an indolent RCC could enable the clinical team to adopt a more conservative approach such as active surveillance, especially in older or frail patients. Patel et al. found a statistically significant correlation between the increased use of renal mass biopsy and the use of non-surgical management, including active surveillance [12].

Fig. 8

a Axial CT image pre-biopsy planning image of percutaneous posterior approach of a left renal cell carcinoma (white arrow) and (b) image demonstrating a coaxial biopsy needle system (yellow arrow) within the left renal cell carcinoma (white arrow). c Subcapsular haematoma (yellow arrow) post-percutaneous biopsy of the left anterior renal cell carcinoma (white arrow). The 18-gauge core biopsies confirmed the diagnosis of mucinous tubular and spindle cell renal cell carcinoma

It is, therefore, unsurprising that the use of percutaneous image-guided renal biopsies has been on the rise. In 2015, approximately 15.3% of patients presenting with a renal mass received a percutaneous biopsy, increased from approximately 8.0% in 2004–2007 [12]. There are concerns, however, that percutaneous image-guided renal biopsies remain underutilised in the management of renal masses [50] especially as up to 30% of surgically excised renal tumours were benign and small, measuring < 4 cm in size [51]. Approximately 32–56% of urologists surveyed indicated that they would not obtain pre-operative biopsy [50, 52]. The number of surgically resected benign renal masses in the USA increased by 82% from 2000 to 2009 [53]. In addition, the almost doubled incidence of RCC and the corresponding increased rates of nephrectomy over the past 20 years have not been matched by improved mortality rates for RCC [54]. On the contrary, the mortality rates for RCC have remained stable, suggesting overdiagnosis and overtreatment [54].

The diagnostic accuracy of 18-gauge core biopsy of renal masses is generally high, up to > 90% [55]. The non-diagnostic rate of core biopsy of renal masses is approximately 10–20% [43, 56]. The non-diagnostic rate is decreased by approximately 80% with a repeat biopsy [56, 57]. As such, core biopsies are favoured over fine needle aspirates in the diagnosis of solid renal tumours [58]. Core biopsy of renal tumours is highly sensitive (97.5%, CI 96.5–98.5) and specific (96.2%, CI 90.7–100) when diagnostic, reducing surgical excision for the majority of patients with a benign biopsy (approximately 80%) [56]. It has a low false-positive rate of 4.0%, but has a limited negative predictive value of approximately 63.3% (CI 52.4–74.2). 90% of the patients with a non-diagnostic result were found to have malignancy following surgical excision [56].

Core biopsy of renal tumours is safe with low rates of serious complications [42, 58]. The median overall complication rate has been reported as approximately 8.1% (IQR 2.7–11.1%). Of this, the most commonly reported complication is minor haemorrhage or haematoma not requiring treatment [58], which is reported to be as high as 4.9% (Figs. 9, 10) [56]. The incidence of severe haemorrhage requiring treatment is very low at approximately 0.4% to 0.7% [56, 58]. Other less common complications include clinically significant pain (1.2%), gross haematuria (1.0%) and pneumothorax (0.6%) [56]. The risk of tumour seeding from RCC along the percutaneous biopsy tract is very low, estimated at approximately 0.01% [59], potentially owing to the slow-growing nature of RCC and the use of a coaxial biopsy technique [60].

Fig. 9

Post-contrast arterial phase axial CT images of a patient following two 14-gauge non-targeted core biopsies of the left kidney, demonstrating (a) left perinephric haematoma (white arrow). There is also a haematoma of the left psoas muscle, which is expanded (yellow arrow). b Active extravasation of contrast from a left inferior segmental renal artery (red arrow) was demonstrated inferiorly within the perinephric haematoma (white arrow). The active haemorrhage was successfully treated with embolisation coils of the left inferior segmental renal artery. The core biopsies confirmed IgA nephropathy

Fig. 10

Unenhanced (a) axial and (b) coronal, CT images of a subcapsular haematoma (red arrow) following an ultrasound-guided non-targeted 14-gauge core biopsy of a right iliac fossa renal transplant allograft (white arrow). The patient had a moderate volume of ascites (yellow arrow) present prior to the biopsy. c An ultrasound-guided non-targeted core biopsy of the right iliac fossa renal graft (white arrow) was performed with a 14-gauge needle (yellow arrow) for deteriorating renal function. The single-pass 14-gauge core biopsy demonstrated features of acute on chronic graft rejection

The incidence of pseudoaneurysm following percutaneous renal biopsy is unknown, probably because most are asymptomatic [60] and incidentally detected on surveillance imaging, including in our cases (Fig. 11b). These were successfully treated with embolisation. Maturen et al. reported a pseudoaneurysm as a late complication of renal biopsy, following delayed presentation of the patient 3 months later with retroperitoneal haemorrhage [60]. Pseudoaneurysms can be detected as a round or oval collection of extravascular arterial contrast that is surrounded by and contained in an adjacent haematoma. Active haemorrhage tends to track into surround tissues and has a linear or flame-like appearance (Figs. 9b, 11), whereas pseudoaneurysms have sharply defined edges and do not blend with the adjacent haematoma [16, 19].

Fig. 11

a Axial contrast-enhanced arterial phase CT image following a CT-guided 18-gauge core biopsy of a left upper pole renal tumour (white arrow) with adjacent perinephric haematoma and stranding (yellow arrow). b A more superior arterial phase axial CT image in the same patient demonstrated active extravasation of contrast (white arrow) within the small left haemothorax (yellow arrow) from a left intercostal artery at T11 (red arrow). c Active contrast extravasation (white arrow) from a left T11 intercostal artery (yellow arrow) was confirmed on angiography and successfully treated with embolisation coils

The development of arteriovenous fistula has been reported in up to 10–15% of patients following percutaneous allograft biopsy in transplant kidney patients [61, 62], with a lower rate of up to 10% following biopsy of native kidneys [62]. Follow-up ultrasound Doppler assessment showed that the majority (> 95%) of the arteriovenous fistulae detected were asymptomatic and approximately 95% of the arteriovenous fistulae spontaneously resolved at 3 months post-biopsy [62]. A small number of the patients developed haemodynamically significant bleeding and requiring treatment. Arteriovenous fistulas lead to early arterial enhancement of the involved vein, with similar enhancement to that of the abdominal aorta and renal arteries (Fig. 12) [63].

Fig. 12

Post-contrast arterial phase axial CT images of vascular complications following non-targeted ultrasound-guided 14-gauge core biopsies of the left kidney in two patients. a Arteriovenous fistula. There is a fistulous connection (red arrow) between the left renal artery (white arrow) and the left renal vein (yellow) with associated early arterialised enhancement of the proximal left renal vein, medial to the arteriovenous fistula. There is an associated retroperitoneal haematoma (black arrow). b Arterial pseudoaneurysm. A small pseudoaneurysm (red arrow) arising from a segmental branch of the left renal artery (yellow arrow) is visualised as an adjacent small focus of rounded arterial enhancement (red arrow). The main left renal artery is also visible (white arrow). There is an associated left perinephric and retroperitoneal haematoma (black arrows)

Late complications of core biopsies of renal masses are rare, and a few cases of pseudoaneurysms and arteriovenous fistulae have been reported, following delayed presentation of the patient with haematuria, retroperitoneal haemorrhage or pain, a few months following the biopsy [60, 64, 65].

A systematic review and meta-analysis suggest that the use of smaller gauge needles may lower complication rates [66]. A randomised trial comparing the safety and diagnostic rates of renal transplant biopsy using a semiautomated biopsy gun with three differently sized biopsy needles (14, 16 or 18 gauge) found that the larger needle size had better diagnostic yield, but was associated with more post-procedural pain. The authors concluded that the use of a 16-gauge needle for renal allograft biopsies would offer the best compromise between diagnostic yield and patient acceptability [67]. In addition, patient selection may affect outcome as studies with higher serum creatinine levels, more women and higher rates of acute kidney injury recorded higher complication rates [66]. For non-targeted biopsies, polar biopsies have a lower complication rate compared with interpolar biopsies, as does avoiding the medulla and using an angle of attack of 50–70° which also increased the diagnostic yield [68].


Nephron-sparing procedures such as partial nephrectomy and percutaneous thermal ablation are increasingly used to treat small renal cell carcinomas (RCC), staged as T1a, i.e. not exceeding 4 cm in size, and can also be used for symptomatic control in larger T1b lesions. Percutaneous thermal ablation techniques, such as radiofrequency ablation, cryoablation, laser or microwave ablation, are also increasingly favoured, particularly in patients who are not suitable surgical candidates.

The post-procedural complications following minimally invasive ablative techniques are similar to the post-surgical complications, with the most common post-ablative complication also being haemorrhage. Most scans during or immediately following renal ablation procedures demonstrate minor perinephric haemorrhage, most commonly of no clinical significance, regardless of the ablation technique used. Haemorrhage may also be visualised along the applicator tracts following intravenous contrast administration [69]. The post-procedural haematoma may be perinephric or subcapsular. Large subcapsular haematomas can lead to renal failure due to renal parenchymal compression [70]. Injury to the collecting system or ureters can also occur following ablative therapy, leading to ureteric perforation or stenosis [69]. There are also several techniques that can be employed to protect adjacent structures including patient positioning, pneumo- or hydro-dissection, retrograde ureteral grade stent placement and irrigation and iatrogenic pneumothorax in upper pole renal masses to reduce the thermal effects [71].

Percutaneous management options of upper renal tract obstruction include percutaneous nephrostomy (PCN) or an internalised antegrade stent depending on the aetiology. PCN is often a more emergent procedure particularly in the setting of an infected, obstructed kidney. This may be due to intraluminal obstruction, for example, calculi, or extrinsic compression, in the case of retroperitoneal fibrosis. If the cause of the obstruction can be relieved and any associated infection treated, the nephrostomy can eventually be capped and subsequently removed. However, if the obstruction cannot be relieved, the placement of a ureteric stent may be necessary. This is performed percutaneously via the nephrostomy in an antegrade fashion. Other indications for PCN include urinary diversion to treat urinary leaks, fistulae and haemorrhagic cystitis, or to provide access to the urinary collecting system to deliver medication or to remove of malpositioned stents [72].

Major complications following percutaneous management of upper renal tract obstruction are rare, between 3 and 4%, and include bleeding requiring transfusion or surgical management or severe sepsis [73]. The overall complication rate for PCN is approximately 10% with very high insertion success rates between 82 and 100% [72]. More common minor complications include perforation of the renal pelvis, seen as contrast extravasation of contrast (Fig. 13), resulting in urine leak. With the successful placement of a PCN, this usually requires no further intervention.

Fig. 13

Selected AP fluoroscopic acquisitions during percutaneous nephrostomy (PCN) exchange and insertion of an antegrade stent. a Magnified projection demonstrating extravasation of contrast (red arrow) and opacification of the collecting system (white arrow). b Acquisition on completion demonstrating PCN (yellow arrow) and position of the antegrade stent (black arrows)

Delayed complications

Nephrocolic fistula

Nephrocolic fistulas, abnormal fistulous connections between the kidney and colon, are rare. There have been a few case reports of nephrocolic fistulae following renal interventions such as lithotripsy [74,75,76], radiofrequency ablation [77], cryoablation [78,79,80,81,82] and stereotactic ablative body radiotherapy [83]. Patients presented with flank pain, recurrent urinary tract infections, pneumaturia, faecuria or haematochezia a few weeks to a few months following ablative therapy or radiotherapy. Nephrocolic fistulas can be detected by the presence of faecal material within the fistulous connection and within the affected kidney (Fig. 14).

Fig. 14

a Axial and b coronal enhanced CT images of a nephrocolonic fistula approximately 9 months following completion of 42 Gy of stereotactic ablative body radiotherapy of a left clear cell renal cell carcinoma. Faecal material is present within the fistulous connection (red arrow) between the descending colon (white arrow) and left kidney (yellow arrow)

Tumour recurrence

A small number of tumours recur following partial nephrectomy. Antic et al. in their literature review found that this occurred in approximately 1% of cases reviewed following partial nephrectomy with a time to recurrence ranging from approximately 3 to 24 months. Patients with underlying familial syndromes, or histologically more aggressive, or multifocal tumours may be at higher risk of developing tumour recurrence [84] (Fig. 15).

Fig. 15

Axial contrast-enhanced CT image of recurrent renal cell carcinoma at a partial nephrectomy site at the mid-pole of the right kidney, as demonstrated by nodular enhancement (yellow arrow) at the site of the partial nephrectomy, usually hypodense (white arrow)

A systematic review and meta-analysis showed no significant difference in the rates of tumour recurrence following thermal ablation compared with partial nephrectomy [85]. The ablation zones appear as low-attenuation regions which may enlarge in the first few days and ultimately involute and scar. In the first few months following treatment, foci of haemorrhage may be detected as areas of increased attenuation on CT or increased signal density on MRI. A thin peripheral rim of enhancement may persist for several months following successful ablation. Successfully treated renal tumours will cease to demonstrate contrast enhancement on MRI and on CT. The presence of residual or recurrent tumour can be indicated by nodular or crescenteric contrast enhancement within the treated regions and/or by the serial increase in tumour size [4].

Tumour seeding

Tumour seeding along the percutaneous biopsy tract is rare, with an estimated incidence of approximately 1 in 3,000 [86]. Patients with papillary renal carcinoma [86], higher grade or stage tumour may be at higher risk of tumour seeding [87]. Tumour seeding following surgery is also extremely rare, accounting for less than 0.1% of cases [88]. Transitional cell carcinomas make up the majority of cases [89]. Two cases of seeding from renal cell carcinoma along the cryoablation probe tract have been reported [90, 91]. Intraperitoneal metastases have also been reported following radiofrequency ablation [92]. Port site metastases are associated with poor prognosis [93]. The foci of tumour seeding typically demonstrate similar imaging characteristics to the primary tumour (Fig. 16).

Fig. 16

a T1-weighted and (b) T2-weighted fat suppressed MR and (c) PET-CT images of TCC recurrence within the right anterolateral abdominal wall scar (white arrow)


The incidence of complications from renal interventions is expected to increase with the increasing incidence of renal pathologies. The radiologist’s role in detecting potential complications on imaging from renal interventions is, as such, more important than ever, especially with the general shift to less invasive approaches. Prompt recognition of the CT findings is vital, particularly as some of the potential complications can be life-threatening. Therefore, an understanding of early and delayed complications from a variety of renal interventions will allow the radiologist to direct prompt and appropriate management.

Availability of data and materials

All data generated or analysed during this study are included in this published article.



Computed tomography


Digital subtraction angiography


Extracorporeal shock wave lithotripsy


Magnetic resonance imaging


Percutaneous nephrostomy


Percutaneous nephrolithotomy


Renal cell carcinoma


  1. 1.

    Pantuck AJ, Zisman A, Belldegrun AS (2001) The changing natural history of renal cell carcinoma. J Urol 166(5):1611–1623

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Hesse A, Brändle E, Wilbert D, Köhrmann K-U, Alken P (2003) Study on the prevalence and incidence of urolithiasis in Germany comparing the years 1979 vs. 2000. Eur Urol 44(6):709–713

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Kittanamongkolchai W, Vaughan LE, Enders FT et al (2018) The changing incidence and presentation of urinary stones over 3 decades. Mayo Clin Proc 93(3):291–299

    PubMed  Article  Google Scholar 

  4. 4.

    Nicol D, Elstob A, Anderson C, Munneke G (2018) Subtotal nephrectomy and tumour ablation. In: Woodhouse CRJ, Kirkham A, (eds) Radiology and follow-up of urologic surgery. Wiley Blackwell, Hoboken, NJ, pp 5–21

  5. 5.

    Jayson M, Sanders H (1998) Increased incidence of serendipitously discovered renal cell carcinoma. Urology 51(2):203–205

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Kane CJ, Mallin K, Ritchey J, Cooperberg MR, Carroll PR (2008) Renal cell cancer stage migration: analysis of the National Cancer Data Base. Cancer 113(1):78–83

    PubMed  Article  Google Scholar 

  7. 7.

    Iguchi M, Umekawa T, Katoh Y, Kohri K, Kurita T (1996) Prevalence of urolithiasis in Kaizuka City, Japan–an epidemiologic study of urinary stones. Int J Urol 3(3):175–179

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Ljungberg B, Campbell SC, Choi HY et al (2011) The epidemiology of renal cell carcinoma. Eur Urol 60(4):615–621

    PubMed  Article  Google Scholar 

  9. 9.

    Wong MCS, Goggins WB, Yip BHK et al (2017) Incidence and mortality of kidney cancer: temporal patterns and global trends in 39 countries. Sci Rep 7(1):15698

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  10. 10.

    Geraghty RM, Jones P, Somani BK (2017) Worldwide trends of urinary stone disease treatment over the last two decades: a systematic review. J Endourol 31(6):547–556

    PubMed  Article  Google Scholar 

  11. 11.

    Durner L, Bach C, El Fatih El Howairis M, Hakenberg OW, Buchholz N (2016) Current trends in urolithiasis treatment in various european health systems. Urol Int 96(2):125–131

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    Patel HD, Nichols PE, Su ZT et al (2020) Renal mass biopsy is associated with reduction in surgery for early-stage kidney cancer. Urology 135:76–81

    PubMed  Article  Google Scholar 

  13. 13.

    Krabbe LM, Bagrodia A, Margulis V, Wood CG (2014) Surgical management of renal cell carcinoma. Semin Intervent Radiol 31(1):27–32

    PubMed  PubMed Central  Article  Google Scholar 

  14. 14.

    Kim TS, Park JG, Kang H, Kang SH, Rhew HY, Kang PM (2016) Computed tomography imaging features and changes in hemostatic agents after laparoscopic partial nephrectomy. J Endourol 30(9):950–957

    PubMed  Article  Google Scholar 

  15. 15.

    Kriegmair MC, Mandel P, Rathmann N, Diehl SJ, Pfalzgraf D, Ritter M (2015) Open partial nephrectomy for high-risk renal masses is associated with renal pseudoaneurysms: assessment of a severe procedure-related complication. Biomed Res Int 205:981251

    Google Scholar 

  16. 16.

    Harris AC, Zwirewich CV, Lyburn ID, Torreggiani WC, Marchinkow LO (2001) Ct findings in blunt renal trauma. Radiographics 21 Spec No:S201–S214

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Sivit CJ, Peclet MH, Taylor GA (1989) Life-threatening intraperitoneal bleeding: demonstration with CT. Radiology 171(2):430

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Lane MJ, Katz DS, Shah RA, Rubin GD, Jeffrey RB Jr (1998) Active arterial contrast extravasation on helical CT of the abdomen, pelvis, and chest. AJR Am J Roentgenol 171(3):679–685

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    Jeffrey RB Jr, Cardoza JD, Olcott EW (1991) Detection of active intraabdominal arterial hemorrhage: value of dynamic contrast-enhanced CT. AJR Am J Roentgenol 156(4):725–729

    PubMed  Article  Google Scholar 

  20. 20.

    Gill IS, Kavoussi LR, Lane BR (2007) Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178(1):41–46

    PubMed  Article  Google Scholar 

  21. 21.

    Takagi T, Kondo T, Tajima T, Campbell SC, Tanabe K (2014) Enhanced computed tomography after partial nephrectomy in early postoperative period to detect asymptomatic renal artery pseudoaneurysm. Int J Urol 21(9):880–885

    PubMed  Article  Google Scholar 

  22. 22.

    Tanagho YS, Kaouk JH, Allaf ME et al (2013) Perioperative complications of robot-assisted partial nephrectomy: analysis of 886 patients at 5 United States centers. Urology 81(3):573–579

    PubMed  Article  Google Scholar 

  23. 23.

    Mehra K, Manikandan R, Dorairajan LN, Sreerag S, Jain A, Bokka SH (2019) Trifecta outcomes in open, laparoscopy or robotic partial nephrectomy: does the surgical approach matter? J Kidney Cancer VHL 6(1):8–12

    PubMed  PubMed Central  Article  Google Scholar 

  24. 24.

    Cassar K, Munro A (2002) Iatrogenic splenic injury. J R Coll Surg Edinb 47(6):731–741

    CAS  PubMed  Google Scholar 

  25. 25.

    Kaplan JR, Lee Z, Eun DD, Reese AC (2016) Complications of minimally invasive surgery and their management. Curr Urol Rep 17(6):47

    PubMed  Article  Google Scholar 

  26. 26.

    Leibl BJ, Schmedt CG, Schwarz J, Kraft K, Bittner R (1999) Laparoscopic surgery complications associated with trocar tip design: review of literature and own results. J Laparoendosc Adv Surg Tech A 9(2):135–140

    CAS  PubMed  Article  Google Scholar 

  27. 27.

    Smith D, Allen C (2017) Imaging after endo-urological stone treatment. In: Woodhouse CRJ, Kirkham A (eds) Radiology and follow-up of urologic surgery. Wiley, Blackwell, pp 37–56

  28. 28.

    Heers H, Turney BW (2016) Trends in urological stone disease: a 5-year update of hospital episode statistics. BJU Int 118(5):785–789

    PubMed  Article  Google Scholar 

  29. 29.

    Dhar NB, Thornton J, Karafa MT, Streem SB (2004) A multivariate analysis of risk factors associated with subcapsular hematoma formation following electromagnetic shock wave lithotripsy. J Urol 172(6 Pt 1):2271–2274

    PubMed  Article  Google Scholar 

  30. 30.

    Schregel C, John H, Randazzo M, Keller I (2017) Influence of acetylsalicylic acid and low-molecular weight heparins on the formation of renal hematoma after shock wave lithotripsy. World J Urol 35(12):1939–1946

    CAS  PubMed  Article  Google Scholar 

  31. 31.

    Naranjo Munoz J, Narváez C, Villanego F, Mazuecos MA, Ceballos M (2018) Page kidney as a complication after a shock wave lithotripsy: a case report. CEN Case Rep 7(2):330–331

    PubMed  PubMed Central  Article  Google Scholar 

  32. 32.

    Simunovic D, Sudarevic B, Galic J (2010) Extracorporeal shockwave lithotripsy in elderly: impact of age and comorbidity on stone-free rate and complications. J Endourol 24(11):1831–1837

    PubMed  Article  Google Scholar 

  33. 33.

    Turgut M, Can C, Yenilmez A, Akcar N (2007) Perforation of the upper ureter: a rare complication of extracorporeal shock wave lithotripsy. Urol Res 35(4):215–218

    PubMed  Article  Google Scholar 

  34. 34.

    Georgescu D, Mulţescu R, Geavlete B, Geavlete P (2014) Intraoperative complications after 8150 semirigid ureteroscopies for ureteral lithiasis: risk analysis and management. Chirurgia (Bucur) 109(3):369–374

    CAS  Google Scholar 

  35. 35.

    Perez Castro E, Osther PJ, Jinga V et al (2014) Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: the Clinical Research Office of the Endourological Society ureteroscopy global study. Eur Urol 66(1):102–109

    PubMed  Article  Google Scholar 

  36. 36.

    Srisubat A, Potisat S, Lojanapiwat B, Setthawong V, Laopaiboon M (2014) Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev 11:Cd007044

    Google Scholar 

  37. 37.

    Kamphuis GM, Baard J, Westendarp M, de la Rosette JJMCH (2015) Lessons learned from the CROES percutaneous nephrolithotomy global study. World J Urol 33(2):223–233

    PubMed  Article  Google Scholar 

  38. 38.

    Barba HS, Villeda-Sandoval CI, Mendez-Probst CE (2020) Frequency and risk factors for antegrade ureteral stone migration after percutaneous nephrolithotomy. Cent European J Urol 73(3):355–361

    PubMed  PubMed Central  Google Scholar 

  39. 39.

    Michel MS, Trojan L, Rassweiler JJ (2007) Complications in percutaneous nephrolithotomy. Eur Urol 51(4):899–906

    PubMed  Article  Google Scholar 

  40. 40.

    Luciani LG, Cestari R, Tallarigo C (2000) Incidental renal cell carcinoma-age and stage characterization and clinical implications: study of 1092 patients (1982–1997). Urology 56(1):58–62

    CAS  PubMed  Article  Google Scholar 

  41. 41.

    Rabjerg M, Mikkelsen MN, Walter S, Marcussen N (2014) Incidental renal neoplasms: is there a need for routine screening? A Danish single-center epidemiological study. APMIS 122(8):708–714

    PubMed  Article  Google Scholar 

  42. 42.

    Lim CS, Schieda N, Silverman SG (2019) Update on indications for percutaneous renal mass biopsy in the era of advanced CT and MRI. AJR Am J Roentgenol 27:1–10

    Google Scholar 

  43. 43.

    Finelli A, Ismaila N, Bro B et al (2017) Management of small renal masses: American Society of clinical oncology clinical practice guideline. J Clin Oncol 35(6):668–680

    PubMed  Article  Google Scholar 

  44. 44.

    Campbell S, Uzzo RG, Allaf ME et al (2017) Renal mass and localized renal cancer: AUA guideline. J Urol 198(3):520–529

    PubMed  Article  Google Scholar 

  45. 45.

    Korbet SM (2002) Percutaneous renal biopsy. Semin Nephrol 22(3):254–267

    PubMed  Article  Google Scholar 

  46. 46.

    Pagnini F, Cervi E, Maestroni U et al (2020) Imaging guided percutaneous renal biopsy: do it or not? Acta Biomed 91(8-S):81–88

    PubMed  PubMed Central  Google Scholar 

  47. 47.

    Bandari J, Fuller TW, TurnerIi RM, D’Agostino LA (2016) Renal biopsy for medical renal disease: indications and contraindications. Can J Urol 23(1):8121–8126

    PubMed  Google Scholar 

  48. 48.

    Rahbar H, Bhayani S, Stifelman M et al (2014) Evaluation of renal mass biopsy risk stratification algorithm for robotic partial nephrectomy–could a biopsy have guided management? J Urol 192(5):1337–1342

    PubMed  Article  Google Scholar 

  49. 49.

    Richard PO, Jewett MAS, Bhatt JR et al (2015) Renal tumor biopsy for small renal masses: a single-center 13-year experience. Eur Urol 68(6):1007–1013

    PubMed  Article  Google Scholar 

  50. 50.

    Patel RM, Safiullah S, Okhunov Z et al (2018) Pretreatment diagnosis of the small renal mass: status of renal biopsy in the United States of America. J Endourol 32(9):884–890

    PubMed  Article  Google Scholar 

  51. 51.

    Corcoran AT, Russo P, Lowrance WT et al (2013) A review of contemporary data on surgically resected renal masses–benign or malignant? Urology 81(4):707–713

    PubMed  Article  Google Scholar 

  52. 52.

    Kümmerlin IP, Borrego J, Wink MH et al (2007) Nephron-sparing surgery and percutaneous biopsies in renal-cell carcinoma: a global impression among endourologists. J Endourol 21(7):709–713

    PubMed  Article  Google Scholar 

  53. 53.

    Johnson DC, Vukina J, Smith AB et al (2015) Preoperatively misclassified, surgically removed benign renal masses: a systematic review of surgical series and United States population level burden estimate. J Urol 193(1):30–35

    PubMed  Article  Google Scholar 

  54. 54.

    Welch HG, Skinner JS, Schroeck FR, Zhou W, Black WC (2018) Regional variation of computed tomographic imaging in the United States and the Risk of Nephrectomy. JAMA Intern Med 178(2):221–227

    PubMed  Article  Google Scholar 

  55. 55.

    Wang R, Wolf JS Jr, Wood DP Jr, Higgins EJ, Hafez KS (2009) Accuracy of percutaneous core biopsy in management of small renal masses. Urology 73(3):586–590

    PubMed  Article  Google Scholar 

  56. 56.

    Patel HD, Johnson MH, Pierorazio PM et al (2016) Diagnostic accuracy and risks of biopsy in the diagnosis of a renal mass suspicious for localized renal cell carcinoma: systematic review of the literature. J Urol 195(5):1340–1347

    PubMed  PubMed Central  Article  Google Scholar 

  57. 57.

    Leveridge MJ, Finelli A, Kachura JR et al (2011) Outcomes of small renal mass needle core biopsy, nondiagnostic percutaneous biopsy, and the role of repeat biopsy. Eur Urol 60(3):578–584

    PubMed  Article  Google Scholar 

  58. 58.

    Marconi L, Dabestani S, Lam TB et al (2016) Systematic review and meta-analysis of diagnostic accuracy of percutaneous renal tumour biopsy. Eur Urol 69(4):660–673

    PubMed  Article  Google Scholar 

  59. 59.

    Herts BR, Baker ME (1995) The current role of percutaneous biopsy in the evaluation of renal masses. Semin Urol Oncol 13(4):254–261

    CAS  PubMed  Google Scholar 

  60. 60.

    Maturen KE, Nghiem HV, Caoili EM et al (2007) Renal mass core biopsy: accuracy and impact on clinical management. AJR Am J Roentgenol 188(2):563–570

    PubMed  Article  Google Scholar 

  61. 61.

    Merkus JW, Zeebregts CJ, Hoitsma AJ, van Asten WN, Koene RA, Skotnicki SH (1993) High incidence of arteriovenous fistula after biopsy of kidney allografts. Br J Surg 80(3):310–312

    CAS  PubMed  Article  Google Scholar 

  62. 62.

    Sosa-Barrios RH, Burguera V, Rodriguez-Mendiola N et al (2017) Arteriovenous fistulae after renal biopsy: diagnosis and outcomes using Doppler ultrasound assessment. BMC Nephrol 18(1):365

    PubMed  PubMed Central  Article  Google Scholar 

  63. 63.

    Yuh BI, Cohan RH (1999) Different phases of renal enhancement: role in detecting and characterizing renal masses during helical CT. AJR Am J Roentgenol 173(3):747–755

    CAS  PubMed  Article  Google Scholar 

  64. 64.

    Voiculescu A, Brause M, Engelbrecht V, Sandmann W, Pfeiffer T, Grabensee B (2003) Hemodynamically relevant hematuria several months after biopsy of a kidney graft: an unusual cause. Clin Nephrol 59(3):217–221

    CAS  PubMed  Article  Google Scholar 

  65. 65.

    Nakatani T, Uchida J, Han YS et al (2003) Renal allograft arteriovenous fistula and large pseudoaneurysm. Clin Transplant 17(1):9–12

    PubMed  Article  Google Scholar 

  66. 66.

    Corapi KM, Chen JLT, Balk EM, Gordon CE (2012) Bleeding complications of native kidney biopsy: a systematic review and meta-analysis. Am J Kidney Dis 60(1):62–73

    PubMed  Article  Google Scholar 

  67. 67.

    Nicholson ML, Wheatley TJ, Doughman TM et al (2000) A prospective randomized trial of three different sizes of core-cutting needle for renal transplant biopsy. Kidney Int 58(1):390–395

    CAS  PubMed  Article  Google Scholar 

  68. 68.

    Sawicka K, Hassan N, Dumaine C (2019) Direction of the biopsy needle in ultrasound-guided renal biopsy impacts specimen adequacy and risk of bleeding. Can Assoc Radiol J 70(4):361–366

    PubMed  Article  Google Scholar 

  69. 69.

    Kurup AN (2014) Percutaneous ablation for small renal masses-complications. Semin Intervent Radiol 31(1):42–49

    PubMed  PubMed Central  Article  Google Scholar 

  70. 70.

    Zhao LC, Chan SW, Macejko AM, Lin WW (2008) Percutaneous radiofrequency ablation-induced perinephric hematoma with acute renal failure in a solitary kidney. J Endourol 22(7):1463–1465

    PubMed  Article  Google Scholar 

  71. 71.

    Uppot RN, Silverman SG, Zagoria RJ, Tuncali K, Childs DD, Gervais DA (2009) Imaging-guided percutaneous ablation of renal cell carcinoma: a primer of how we do it. AJR Am J Roentgenol 192(6):1558–1570

    PubMed  Article  Google Scholar 

  72. 72.

    Pabon-Ramos WM, Dariushnia SR, Walker TG et al (2016) Quality improvement guidelines for percutaneous nephrostomy. J Vasc Interv Radiol 27(3):410–414

    PubMed  Article  Google Scholar 

  73. 73.

    Montvilas P, Solvig J, Johansen TE (2011) Single-centre review of radiologically guided percutaneous nephrostomy using “mixed” technique: success and complication rates. Eur J Radiol 80(2):553–558

    PubMed  Article  Google Scholar 

  74. 74.

    Neustein P, Barbaric ZL, Kaufman JJ (1986) Nephrocolic fistula: a complication of percutaneous nephrostolithotomy. J Urol 135(3):571–573

    CAS  PubMed  Article  Google Scholar 

  75. 75.

    Lang EK, Hanano A, Colon I (2009) Colon caliceal fistula: a complication of percutaneous nephrolithotripsy. J Urol 182(4):1580

    PubMed  Article  Google Scholar 

  76. 76.

    Akbani S, Wolf JS Jr, Osterberg EC (2019) Enterorenal fistula as an unusual complication from ureteroscopic lithotripsy: a case report. J Endourol Case Rep 5(2):49–52

    PubMed  PubMed Central  Article  Google Scholar 

  77. 77.

    Patel BJ, Mathur AK, Puri N, Jackson CS (2014) A rare case of nephrocolic fistula resulting from radio frequency ablation (RFA) of renal cell carcinoma. ACG Case Rep J 1(2):93–95

    PubMed  PubMed Central  Article  Google Scholar 

  78. 78.

    Miyazaki M, Komatsu Y, Yoshihara T, Kimura S (2020) Bowel injury complicating percutaneous cryoablation of large renal cell carcinoma. Radiol Case Rep 15(5):580–585

    PubMed  PubMed Central  Article  Google Scholar 

  79. 79.

    Mozo M, Gonzálo R, Gutiérrez JM (2018) Colorenal fistula after renal tumour cryotherapy. Int J Surg Case Rep 53:441–443

    PubMed  PubMed Central  Article  Google Scholar 

  80. 80.

    Morgan AI, Doble A, Davies RJ (2012) Successful conservative management of a colorenal fistula complicating percutaneous cryoablation of renal tumors: a case report. J Med Case Rep 6:365

    PubMed  PubMed Central  Article  Google Scholar 

  81. 81.

    Vanderbrink BA, Rastinehad A, Caplin D, Ost MC, Lobko I, Lee BR (2007) Successful conservative management of colorenal fistula after percutaneous cryoablation of renal-cell carcinoma. J Endourol 21(7):726–729

    PubMed  Article  Google Scholar 

  82. 82.

    Wysocki JD, Joshi V, Eiser JW, Gil N (2010) Colo-renal fistula: An unusual cause of hematochezia. World J Gastrointest Pathophysiol 1(3):106–108

    PubMed  PubMed Central  Article  Google Scholar 

  83. 83.

    Brinded A, Tay YK, Woods R (2020) Novel case of nephrocolic fistula secondary to stereotactic ablative body radiotherapy for clear cell renal cell carcinoma. ANZ J Surg 90(9):1800–1801

    PubMed  Article  Google Scholar 

  84. 84.

    Antic T, Taxy JB (2015) Partial nephrectomy for renal tumors: lack of correlation between margin status and local recurrence. Am J Clin Pathol 143(5):645–651

    PubMed  Article  Google Scholar 

  85. 85.

    Rivero JR, De La Cerda J 3rd, Wang H et al (2018) Partial nephrectomy versus thermal ablation for clinical stage T1 renal masses: systematic review and meta-analysis of more than 3,900 patients. J Vasc Interv Radiol 29(1):18–29

    PubMed  Article  Google Scholar 

  86. 86.

    Renshaw AA, Powell A, Caso J, Gould EW (2019) Needle track seeding in renal mass biopsies. Cancer Cytopathol 127(6):358–361

    PubMed  Article  Google Scholar 

  87. 87.

    Park SH, Oh YT, Jung DC, Cho NH, Choi YD, Park SY (2017) Abdominal seeding of renal cell carcinoma: radiologic, pathologic, and prognostic features. Abdom Radiol (NY) 42(5):1510–1516

    Article  Google Scholar 

  88. 88.

    Ploumidis A, Panoskaltsis T, Gavresea T, Yiannou P, Yiannakou N, Pavlakisc K (2013) Tumor seeding incidentally found two years after robotic-Assisted radical nephrectomy for papillary renal cell carcinoma. A case report and review of the literature. Int J Surg Case Rep 4(6):561–564

    PubMed  PubMed Central  Article  Google Scholar 

  89. 89.

    Castillo OA, Vitagliano G (2008) Port site metastasis and tumor seeding in oncologic laparoscopic urology. Urology 71(3):372–378

    PubMed  Article  Google Scholar 

  90. 90.

    Allen BC, Remer EM (2010) Percutaneous cryoablation of renal tumors: patient selection, technique, and postprocedural imaging. Radiographics 30(4):887–900

    PubMed  Article  Google Scholar 

  91. 91.

    Akhavein A, Neuberger MM, Dahm P (2012) Tumour-seeding: a rare complication of ablative therapy for clinically localised renal cell carcinoma. BMJ Case Rep 2012:bcr2012006948

    Article  Google Scholar 

  92. 92.

    Krambeck AE, Farrell MA, Charboneau JW, Frank I, Zincke H (2005) Intraperitoneal drop metastasis after radiofrequency ablation of pararenal tumor recurrences. Urology 65(4):797

    PubMed  Article  Google Scholar 

  93. 93.

    Song J, Kim E, Mobley J et al (2014) Port site metastasis after surgery for renal cell carcinoma: harbinger of future metastasis. J Urol 192(2):364–368

    PubMed  Article  Google Scholar 

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JL acted as chief author, drafted and revised the manuscript and prepared the figures. JH revised the manuscript and provided additional images and content. TS overviewed the work, revised the manuscript and provided cases. All authors read and approved the final manuscript.

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Correspondence to Tom Sutherland.

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Lee, J.S.Z., Hall, J. & Sutherland, T. Complications of renal interventions: a pictorial review of CT findings. Insights Imaging 12, 102 (2021).

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  • Kidney
  • Surgery
  • Biopsy
  • CT
  • Complication