Subcapsular Urinoma: An Unusual Form of Page Kidney in a High School Wrestler (original) (raw)

The Journal of Urology, 2002

Abstract

The Page kidney phenomenon is usually associated with blunt renal trauma and accompanying perinephric or subcapsular hematoma. We describe a case of Page kidney due to a subcapsular urinoma, likely resultant from blunt trauma. CASE REPORT In March 2001 a 16-year-old white male was referred for evaluation of acute right flank pain. The patient’s medical, surgical, social and family histories were remarkable only for a family history of nephrolithiasis and, at the time of evaluation, participation on his high school wrestling team. Physical examination was remarkable for a blood pressure of 140/90 mm. Hg and right flank tenderness. Urinalysis revealed microhematuria. Noncontrast enhanced computerized tomography of the abdomen and pelvis demonstrated bilateral subcapsular fluid collections. Subsequent images, following intravenous administration of contrast agent, showed extravasation of contrast material into the subcapsular fluid collections (fig. 1). For further definition of the nature of the fluid collections the patient underwent magnetic resonance imaging of the kidneys. Characteristics of the fluid collections on T1 and T2-weighted images were consistent with that of urine (fig. 2). In addition, peripheral plasma renin activity was found to be 36 ng./ml. per hour (normal less than 3.3). Hypertension was treated with lisinopril. Initial surgical management included cystoscopy, retrograde pyelography and ureteral stent placement. Retrograde pyelography revealed bilateral pyelotubular backflow, with extravasation of contrast material. A right ureteral stent was placed to optimize drainage of the collecting system as this was the side on which the patient was symptomatic. Following stent placement, the patient refrained from strenuous physical activity. Followup imaging of the kidneys 2 months later showed resolution of the subcapsular fluid collections. In addition, blood pressure normalized, and the patient was weaned off of the antihypertensive medication 4 months after initial presentation.

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