# 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.

## Key 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.