A 42-year-old white male presented with sudden onset of suprapubic and pelvic discomfort associated with gross hematuria. His vitals were stable on admission. A cystogram demonstrated a bladder of normal size and contour with no intravesical filling defect. Computed tomography (CT) revealed thickened bladder wall with possible infiltrating hematoma and obstruction of the right ureter with swelling of kidneys due to urine accumulation (hydronephrosis). The patient also had some other problem in the past such as deep vein thrombosis, basilic vein thrombosis and pulmonary embolism, right testicular vein clot with testicular necrosis, hyperlipidemia and hypertension. There was no family history of a coagulation disorder. The patient was an ex-smoker and denied alcohol use.
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