Spontaneous Hemorrhage in Acquired Renal Cystic Disease

Acquired renal cystic disease is a complication of end-stage renal disease and the prevalence of which is related to dialysis duration. The significance of this condition is its association with neoplasm and spontaneous hemorrhage. A 46-year-old uremic female was seen at the emergency room shortly after hemodialysis because of sudden onset of right upper quadrant pain. A computed tomography of the abdomen without contrast revealed a distinct subhepatic lesion resembling liver abscess. Sonography, however, favored a complex cystic lesion or a solid renal tumor with necrosis. Magnetic resonance imaging concurred with the above findings, yet going further to implicate the possibility of a hematoma. A fist-size hematoma was discovered in the multicystic right kidney during nephrectomy, and the pathologic report showed cystic atypia. Spontaneous hemorrhage in acquired renal cystic disease during long-term dialysis may often confuse the clinician who is unaware of such an entity.