Autosomal-dominant polycystic kidney disease (ADPKD) often presents with hematuria as in this case [1]. However, when conventional imaging (multiphase CT/MRI or angiography) is negative, localizing clinically relevant bleeding can be challenging [2]. In ADPKD patients the presence of cysts with residual blood accumulation, without active bleeding is a challenge for MRI/CT. We report the case of a man presenting with persistent gross hematuria requesting several blood transfusions, where in-vivo labelled [99mTc]Tc-erythrocyte scintigraphy (RBC-scintigraphy) identified the bleeding site despite negative cystoscopy and CT angiography. RBC-scintigraphy has not been described for this clinical situation but is well established for occult gastrointestinal bleeding not seen on CT or MRI [3].
Standard protocol with 923 MBq [99mTc]Tc-RBC was applied, with a dual-head SPECT/CT. Figure A shows, dynamic planar images with an increase in tracer accumulation after 50 min visualized on the right renal upper pole on posterior view (arrow). B) Subsequent quantitative coronal SPECT/CT after 60 min, confirming tracer within the renal pelvis (SUVmax 8.4, arrow). C) To rule out additional bleeding on the contralateral side, a second SPECT/CT was performed after 120 min, confirming an increased tracer accumulation (SUVmax 15.3, arrow), without evidence of bleeding on the left side. D) Embolization of the right kidney was successful, bleeding stopped thereafter, without the need for further blood transfusion.
When conventional imaging is inconclusive, the superior sensitivity of RBC scintigraphy with quantitative SPECT/CT for intermittent bleeding, can localize occult hemorrhage in ADPKD. Precise localization may support targeted embolization and avoid non-selective approaches when feasible.
Author contributions
Irene A. Burger, Maria Wertli, Erwing Grüter and Florian Messmer contributed to the case conception. Material collection and frist draft (Marco Bernard, Cristina Popescu, Alexander W. Sauter, Sabin G. Pop). All authors commented on previous versions and read and approved the final manuscript.
Funding
Open access funding provided by Swiss Federal Institute of Technology Zurich.
Data availability
The data analysed for this case study are available from the corresponding author on reasonable request.
Declarations
Disclosure
All authors confirm no conflict of interests.
Consent
Patient consent was obtained.
Footnotes
Maria Wertli and Irene A. Burger shared last authorship and equal contribution.
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Change history
10/12/2026
This article was originally published under the subscription model but it is now published under an Open Access license.
References
- 1.Kidney Disease: Improving Global Outcomes AWG. KDIGO 2025 clinical practice guideline for the Evaluation, Management, and treatment of autosomal dominant polycystic kidney disease (ADPKD). Kidney Int. 2025;107(2S):S1–239. 10.1016/j.kint.2024.07.009. [DOI] [PubMed] [Google Scholar]
- 2.Suwabe T, Ubara Y, Oba Y, et al. Acute renal intracystic hemorrhage in patients with autosomal dominant polycystic kidney disease. J Nephrol. 2023;36(4):999–1010. 10.1007/s40620-022-01562-z. [DOI] [PubMed] [Google Scholar]
- 3.Yaxley KL, Mulhem A, Godfrey S, Oke JL. The accuracy of computed tomography angiography compared with Technetium-99m labelled red blood cell scintigraphy for the diagnosis and localization of acute Gastrointestinal bleeding: A systematic review and Meta-Analysis. Curr Probl Diagn Radiol. 2023;52(6):546–59. 10.1067/j.cpradiol.2023.05.004. [DOI] [PubMed] [Google Scholar]
Associated Data
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Data Availability Statement
The data analysed for this case study are available from the corresponding author on reasonable request.