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July 25, 1977

Vasovagal Pseudohemorrhage

Author Affiliations

Episcopal Hospital Philadelphia

JAMA. 1977;238(4):304. doi:10.1001/jama.1977.03280040024005

To the Editor.—  The communication by Bolton et al was read with interest. There was obviously clear evidence for actual bleeding after the biopsy: pain in the abdomen associated with guarding and muscle spasm in the left upper quadrant, a substantial drop in blood pressure and in hematocrit, and initial postural hypotension even after fluid, colloid, and blood infusions. The observation of bradycardia can be explained by the synergistic activity of hydroxyzine hydrochloride and meperidine hydrochloride.Our observations, as well as recent observations by others,1,2 clearly demonstrate that the use of diagnostic ultrasound is the best means currently available to localize the kidney to be biopsied percutaneously and to determine the presence of certain complications after biopsy such as perirenal hematoma (which may not be readily discernable either on plain films or by intravenous urography).It must be emphasized that percutaneous renal biopsy remains a procedure with potential for