The majority of patients presenting with renal and/or peri-renal hemorrhage are diagnosed with an underlying etiology. Non-traumatic spontaneous idiopathic renal hemorrhage is an infrequently reported entity. Management of these patients is critical; diagnosis is established only once any surgically correctable etiology is excluded. A 57 year old Caucasian female with no significant past medical history presented to an outside emergency department with a one day history of right lower back pain and fatigue. An abdominal and pelvic computed tomography (CT) at the time revealed a grade IV right renal laceration. We present this unusual case of a previously healthy woman with a low probability for a spontaneous idiopathic non traumatic grade IV renal laceration with perirenal hemorrhage. Though most renal and perirenal hemorrhages are associated with an underlying etiology, in rare circumstances idiopathic non traumatic spontaneous renal laceration manifests with insignificant symptomatology. It is critical for clinicians in the Emergency Department to be aware of this entity to avoid diagnostic error. Prior to categorizing an injury as idiopathic, appropriate evaluation to rule out rare etiologic basis is crucial.