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 accessOne-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 MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Ultrasonography of perinephric fluid: differential diagnosis and image interpretation.Ultrasound Med Biol. 2017; 43: S172
- Urinoma.Clin Radiol. 1977; 28: 345-351
- Factors associated with urinoma accompanied by ureteral calculi.Arch Ital Urol Androl. 2019; 91: 11-15
- A unique case of spontaneous bilateral renal subcapsular urinoma secondary to high pressure chronic retention of urine.Urol Case Rep. 2017; 14: 21-23
- Urine leaks and urinomas: diagnosis and imaging-guided intervention.Radiographics. 2003; 23: 1133-1147
- 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
- Page kidney: a rare cause of secondary hypertension.SA J Radiol. 2019; 23: 1762
Article info
Publication history
Published online: March 09, 2022
Accepted:
January 16,
2022
Received in revised form:
January 3,
2022
Received:
October 3,
2021
Identification
Copyright
© 2022 Published by Elsevier Inc.
