Spontaneous perirenal hemorrhage is mainly due to renal malignancy. But its presence in a patient who are on anticoagulant make it challenging for the diagnosis. We report a case of 50-year-old man who presented with brain stroke and started on an anticoagulant. Post anticoagulant treatment he presented with flank fullness. On evaluation, he found to have right perirenal hematoma suspicious of renal malignancy and severely stenosed aortic valve. We did right nephrectomy and aortic valve replacement simultaneous and on histopathologically found to have papillary renal cell carcinoma.
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