Rationale: Infected urinomas are rare complications of urinary tract obstruction and may mimic renal abscess or pyonephrosis. Presentation as a palpable flank mass is highly unusual. Patient’s concern: An 84-year-old man with fever, flank pain, and a firm right flank mass. Imaging revealed an acute multiloculated infected urinoma communicating with the proximal ureter, associated with a ureteric calculus. Diagnosis: Infected urinoma. Interventions: He was treated with antibiotics, percutaneous drainage, and nephrostomy. Outcomes: Recurrence occurred three months later due to unresolved obstruction, requiring repeat drainage. Definitive surgical management was deferred due to advanced age and comorbidities, highlighting challenges in high-risk patients. Lessons: This case highlights the importance of considering urinoma in the differential diagnosis of flank masses, the complementary roles of multimodal imaging for accurate diagnosis, and the importance of definitive management of urinary obstruction to prevent recurrence.
Tan et al. (Sun,) studied this question.