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We present a case of renal subcapsular hemorrhage caused by a small renal cell carcinoma. The patient was a 52-year-old housewife, presenting abdominal pain and vomiting, of abrupt onset. Modern imaging modalities clearly visualized a perirenal or subcapsular hematoma in her left kidney, but no underlying pathology, was found even on the arteriogram. Relying on the statistics based on more than 100 reported cases with the spontaneous renal rupture, nephrectomy was carried out. The renal carcinoma was of granular cell type (G2), and classified as pT2, pN0 and pM0. Difficulties in making a correct diagnosis as to the pathology and therefore a rational decision for nephrectomy were also stressed.
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