Advertisement

Atraumatic Bilateral Renal Subcapsular Urinomas in a Young, Healthy Female

      Abstract

      Background

      Urinomas are rare and generally result from trauma to any part of the urinary collecting system. Appropriate imaging is crucial in the timely diagnosis and management of urinomas and for ruling out other etiologies such as subcapsular renal hematomas and perinephric abscesses.

      Case Report

      A 31-year-old woman with no past medical history or known trauma presented to the Emergency Department (ED) with a week of right flank pain, abdominal pain, and intermittent fevers. On point-of-care ultrasound (POCUS), she was found to have a complex right perinephric collection, later confirmed with computed tomography (CT) imaging. She was treated with intravenous (IV) antibiotics and discharged after a 3-day hospital admission with instructions to follow up with Urology. A day later, she was readmitted with worsening bilateral flank pain and persistent fevers. Image-guided percutaneous aspirations of her bilateral perinephric fluid collections revealed both urine and blood. A right ureteral stent was then placed with ultimate resolution of her symptoms.
      Why Should an Emergency Physician Be Aware of This? Urinomas without history of trauma are rare and should be on the differential for patients presenting with flank pain and infectious symptoms. Urinomas or other expanding perinephric fluid collections can result in superimposed infection, rupture, secondary hypertension, and renal failure. Here, we present an atypical case of atraumatic bilateral renal subcapsular urinomas with hemorrhagic components in a young and healthy woman. Our case further outlines the utility of POCUS in the ED for the timely diagnosis and management of this disease process.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Tsao T-F
        • Chen C-W
        • Huang H-H
        • Tyan Y-S.
        Ultrasonography of perinephric fluid: differential diagnosis and image interpretation.
        Ultrasound Med Biol. 2017; 43: S172
        • McInerney D
        • Jones A
        • Roylance J
        Urinoma.
        Clin Radiol. 1977; 28: 345-351
        • Öğreden E
        • Oǧuz U
        • Karadayı M
        • Demirelli E
        • Tosun A
        • Günaydın M.
        Factors associated with urinoma accompanied by ureteral calculi.
        Arch Ital Urol Androl. 2019; 91: 11-15
        • Maitra NU
        • Conn IG.
        A unique case of spontaneous bilateral renal subcapsular urinoma secondary to high pressure chronic retention of urine.
        Urol Case Rep. 2017; 14: 21-23
        • Titton RL
        • Gervais DA
        • Hahn PF
        • Harisinghani MG
        • Arellano RS
        • Mueller PR.
        Urine leaks and urinomas: diagnosis and imaging-guided intervention.
        Radiographics. 2003; 23: 1133-1147
        • Zhang P
        • Hu W-L.
        Sudden onset of a huge subcapsular renal hematoma following minimally invasive ureteroscopic holmium laser lithotripsy: a case report.
        Exp Ther Med. 2015; 10: 335-337
        • Warnich I
        • Nicolaou M
        • Sofianos Z
        • Pienaar JA
        • Varghese J.
        Page kidney: a rare cause of secondary hypertension.
        SA J Radiol. 2019; 23: 1762