Time for some "Renal Radiology Rounds."
The case involves a 77 year-old man with a history of severe benign prostatic hypertrophy. He had been advised to have a TURP in the past but had repeatedly declined. He was hospitalized for nausea, vomiting and R flank pain without hematuria occurring over a week's time, and it was noted that his creatinine had elevated from its baseline of 1.3 to 7. A CT scan on arrival showed the following:
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This patient had developed a R-sided urinoma, which is simply a collection of urine which results from rupture of the collecting system due to high pressures from obstruction. It is more typically seen in renal transplant patients post-operatively at the site of the surgical anastamosis between the recipient and donor collecting systems; non-surgical cases of urinomas such as this one are more rare. The patient had a decompressive Foley catheter placed and an IR drain placed to remove the fluid collection. The fluid's creatinine level was higher than serum level, indicating urine as the source. He experienced a post-obstructive diuresis with a lowering of his creatinine following these interventions.