Korean J Urol.  2012 Jul;53(7):502-504. 10.4111/kju.2012.53.7.502.

Bilateral Ureteral Stones and Spontaneous Perirenal Hematoma in a Patient with Chronic Idiopathic Thrombocytopenic Purpura

• Akyuz M
• Caliskan S
• Kaya C

• KMID: 1988764
• DOI: http://doi.org/10.4111/kju.2012.53.7.502

Abstract

Idiopathic thrombocytopenic purpura (ITP) is an immune thrombocytopenia with a usually benign clinical course. Bleedings are mostly of the mucocutaneous type with mild symptoms. Massive bleedings requiring transfusion are rarely seen, unless the number of platelets decreases to extremely low levels. In this case, bilateral perirenal hematoma and bilateral distal ureteral stones were detected on a non-contrast computed tomography scan of a 57-year-old male patient who developed macroscopic hematuria during his treatment in the clinics of internal medicine because of left flank pain and diffuse petechial rashes all over his body. The patient, who had been receiving chronic ITP treatment for 1 year, had a very low platelet count (4,000/mm3). The patient was prescribed bed rest, and his platelet count increased to a safe level for surgical intervention of above 50,000/mm3 with administration of prednisolone, intravenous immune globulin, and platelet suspension. A stone-free state was achieved after bilateral ureterorenoscopy and pneumatic lithotripsy. A conservative approach was followed for the perirenal hematoma. Upon regression of the perirenal hematoma, the patient was discharged at 9 weeks postoperatively.

Keyword

Idiopathic; Purpura; Renal hematoma; Thrombocytopenic; Ureteral calculi

MeSH Terms

Bed Rest
Blood Platelets
Exanthema
Flank Pain
Hematoma
Hematuria
Humans
Immunoglobulins, Intravenous
Internal Medicine
Lithotripsy
Male
Middle Aged
Platelet Count
Prednisolone
Purpura
Purpura, Thrombocytopenic, Idiopathic
Thrombocytopenia
Ureter
Ureteral Calculi
Immunoglobulins, Intravenous
Prednisolone

Figure

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  FIG. 1 Computed tomography scan showing bilateral perirenal hematoma.

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  FIG. 2 Computed tomography scan showing a 20-mm distal ureteral stone.

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  FIG. 3 Postoperative computed tomography scan 9 weeks after the diagnosis of perirenal hematoma.

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  FIG. 4 Postoperative magnetic resonance imaging study.

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