[Spontaneous renal hematoma: a rare complication of acute pyelonephritis at the diabetic]

A 65-year-old diabetic woman was admitted with fever and left flank pain due to acute pyelonephritis. Urinalysis showed leukocyturia without hematuria, urine culture revealed Escherichia coli. On the third day of treatment by appropriate antibiotics, her condition worsened and presented collapses and decreased hemoglobinemia without any obvious bleeding. Ultrasonography and computed tomography showed a fluid collection in the subscapular area of the left kidney. A Subsequent percutaneous drainage of this collection yielded the old bloody fluid. A spontaneous renal subcapsular hematoma was diagnosed. A surgical drainage of the hematoma was performed. The patient was discharged with complete recovery

Strategie diagnostique et conduite pratique devant une anemie: D'apres une etude approfondie de 100 patients suivis en medecine interne

Anemia is a frequent reason for seeking medical care in Internal Medicine. It is not a diagnosis, but rather a symptom that needs to be investigated in order to find an etiology. In a retrospective review of 100 cases of anemia, the cause was found in 86% of cases. The etiologic profile was varied. Iron deficiency remained by far the most frequent cause seen in 47% of case. Other etiologies have been found such as neoplasm in 13% of cases, chronic renal failure in 8% of cases and endocrinal cause in 5% of cases. We recommend a diagnostic decision tree that provides a tool for rational and cost effective approach for anemia