Case report: Can fibrinolytics effectively manage gross hematuria and clot retention in an elderly patients, leading to the diagnosis of lymphoma?

TL;DR

An elderly man with severe blood clots in his urinary tract was successfully treated with a clot-dissolving drug, leading to the discovery of lymphoma.

Contribution

Demonstrates the effectiveness of fibrinolytic therapy in managing complex clot retention and uncovering underlying malignancies.

Findings

Alteplase dissolved extensive urinary clots and restored kidney function.

A multidisciplinary approach led to the diagnosis of B-cell lymphoma.

Fibrinolytic therapy avoided the need for dialysis and invasive surgery.

Abstract

A 77-year-old man presented with severe gross hematuria and extensive urinary tract clot retention unresponsive to catheterization and irrigation. CT showed clots throughout the upper and lower tracts; labs revealed pancytopenia and elevated creatinine. Bilateral nephrostomies with multiple Alteplase instillations dissolved clots, restored urinary flow, and normalized renal function. Bone marrow biopsy confirmed B-cell lymphoma. This case highlights fibrinolytic therapy as a minimally invasive option for clot retention and the importance of multidisciplinary evaluation in uncovering malignancies presenting with complex urologic emergencies.

•Alteplase successfully dissolved extensive urinary tract clots.•Multidisciplinary approach revealed B-cell lymphoma.•Fibrinolytics offer a minimally invasive alternative to surgery.•Case emphasizes diagnostic vigilance in elderly hematuria.•Restoration of renal function avoided further dialysis.

Alteplase successfully dissolved extensive urinary tract clots.

Multidisciplinary approach revealed B-cell lymphoma.

Fibrinolytics offer a minimally invasive alternative to surgery.

Case emphasizes diagnostic vigilance in elderly hematuria.

Restoration of renal function avoided further dialysis.

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