AN
UNUSUAL PRESENTATION OF URINOMA: TRE FIRST SYMPTOM OF LUNG CANCER
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MILAN HORA, ONDoEJ HES, LUDMILA BOUDOVÁ, ZDENĚK CHUDÁČEK, JAROSLAV DROPPA
Departments of Urology, Pathology and Radiology, University Hospital, Plzeň, Czech Republic
ABSTRACT
Introduction:
Metastases of lung cancer to kidney are very common but in most cases
they are not clinically significant for urologists.
Case Report: The authors present a case
of urinoma of left retroperitoneum caused by partially necrotic metastases
of lung carcinoma in the left kidney. The urinoma, which presented with
changes of bowel habits resulting in constipation, was the first symptom
of a lung cancer.
Conclusion: It was primary urine that leaked
through the necrotic kidney metastases into the retroperitoneum. The peculiarly
silent clinical manifestation may be explained by the left-sided hemiparesis.
We are not aware of any similar case in the MEDLINE database.
Key words:
kidney neoplasms, secondary; lung neoplasm, symptoms, diagnosis; urinoma
Braz J Urol, 28: 130-131, 2002
INTRODUCTION
A
64-year-old man presented with changes of bowel habits resulting in constipation,
which he had had for about one week. As for his other medical history,
he suffered from chronic ischemic heart disease, insulin non-dependent
diabetes mellitus, and from residual left-sided hemiparesis due to a brain
stroke (which had occurred 10 years prior to the presentation). He was
admitted to hospital and several examinations were performed. Pulmonary
hypertension was noted on a chest X-ray. The colonoscopy and abdominal
ultrasonography showed normal results. Computed tomography (CT) scan revealed
a tumor in the left adrenal gland and urinoma in left retroperitoneum
(1) with leakage of contrast medium (Figure-1). Intravenous urography
displayed leakage of contrast fluid into retroperitoneum, but the source
could not be elucidated. The surgical revision via a left lumbotomy revealed
retroperitoneal structures soaked in transparent odorless fluid and thickening
of the Gerota’s fascia. Moreover, multiple tumor foci in the left
kidney and a neoplastic mass of the left adrenal gland were identified,
prompting nephrectomy and adrenalectomy (Figure-2). Histologically, both
organs were diagnosed to contain partially necrotic metastases of lung
carcinoma. The right lateral X-ray projection of the chest displayed a
centrally located pulmonary tumor of the right lung. Multiple metastases
were revealed in the brain on CT. The patient was given merely symptomatic
therapy afterwards.
COMMENTS
In our opinion, it was primary urine that leaked through the necrotic kidney metastases into the retroperitoneum. The peculiarly silent clinical manifestation may be explained by the left-sided hemiparesis, which obscured the abdominal pain to leave the only symptom of a disturbed bowel function. We are not aware of any similar case in the MEDLINE database.
REFERENCES
- Clayman RV, McDougall EM, Nakada SY: Endosurgical management of an urinoma (uriniferous pseudocyst). In: Walsh PC, Retik AB, Vaughan Jr ED, Wein AJ (eds.). Campbell’s Urology, 7th ed, vol. III, Chapter 12, Philadelphia, Saunders Co., pp. 2804-2805, 1993.
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Received: February 24, 2002
Accepted: March 18, 2002
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Correspondence address:
Dr. Milan Hora
Department of Urology, University Hospital
E. Beneše 13
305 99 Plzeò, Czech Republic
Fax: + + (420) (19) 740-2171
E-mail: horam@fnplzen.cz