A 42-year-old man presented with recurrence of haematuria after extensive body-building exercises.
He had a history of renal failure due to polycystic kidney disease, complicated by recurrent bleeding, particularly after kickboxing or body-building exercises. Ultrasonography and abdominal CT scan without contrast showed widespread polycystic kidney and liver disease. However, the source of bleeding could not be identified. MRI (T2-weighted, half-Fourier acquired single-shot turbo spin echo) showed multiple cysts with decreased signal density , suggestive of recent bleeding; this was further confirmed by distinct fluid levels in some of the cysts. Cyst bleeding is a common complication of polycystic kidney disease, occurring in 30—50% of cases. Our case shows that trauma can be a causative factor. MRI can elegantly reveal the exact location of cysts in which recent bleeding has occurred.