INDIAN PEDIATRICS 997 VOLUME 55 __ NOVEMBER 15, 2018 CASE R R R R REPORT Bilateral Spontaneous Urinoma in a Cyanotic Child SWARNIM SWARNIM 1 , DINESH KUMAR 1 , DHEERAJ BHATT 1 AND SANA SANA 2 From 1 Division of Paediatric Cardiology, Department of Pediatrics, and Department of 2 Radiodiagnosis; Post Graduate Institute of Medical Education and Research and Dr Ram Manohar Lohia Hospital, New Delhi, India. Background: Urinoma is an encapsulated collection of extravasated urine, secondary to trauma or obstructive uropathy. Spontaneous bilateral urinoma is rare. Case characteristics: 7-year-old boy with cyanotic heart disease and fever of unknown origin. Obeservation: The ultrasound abdomen and CT abdomen revealed bilateral spontaneous urinoma which was aspirated and was found to be infected. Following intravenous atibiotics the child became afebrile, with subsequent renal scans showing no recurrence. Message: Hypoxia and consequent polycythemia may be responsible for perinephric leaks leading to Non-traumatic spontaneous urinoma. Keywords: Cyanotic heart disease, Genitourinary system, Perinephric collection. Correspondence to: Dr Swarnim, Room No. 409, Doctors hostel, Ram Manohar Lohia Hospital , New Delhi, India. itsswarnim@gmail.com Received: August 23, 2017; Initial review: February 15, 2018; Accepted: June 14, 2018. Despite treating with broad spectrum antibiotics for more than a week the child continued to have high spiking fever. Widal Test, Malaria card test and peripheral blood smear for malarial parasite, Weil felix test, Dengue and chikungunya serology, Blood and urine culture, Urine for fungal hyphae, and Chest X-ray were non-contributory. The ultrasound scan showed bilateral loculated perinephric fluid collection with thin septa. Contrast- enhanced computed tomography (EECI) scan of the abdomen with a delayed phase was performed to rule out any causes of leak due to obstructive uropathy like calculi, PUJ or VUJ obstruction. MCU was also performed to rule out the presence of posterior urethric valve in the patient. From the perinephric area, 50 mL of pale yellow color fluid resembling urine was aspirated under ultrasound U rinoma is a collection of extravasated urine, lying encapsulated in the perirenal space [1] – obstructive uropathy and abdominal trauma are the commonly implicated causes. Bilateral spontaneous urinoma is rare and uncommonly reported in literature. We are reporting a case of bilateral spontaneous urinoma in the setting of a cyanotic congenital heart disease in a child. CASE REPORT A 7-year-old boy presented with bluish discoloration of body since birth with history of squatting for the past 4 years. He was admitted on account of worsening of cyanosis along with increased frequency of cyanotic spells for the past two months. Examination findings revealed central cyanosis with clubbing with a faint ejection systolic murmur. Abdomen was soft with no organomegly. Other organ systems were normal. Hemogram and biochemical workup were within normal limits except for polycythemia. 2D echocardiography confirmed the diagnosis of Double outlet right ventricle with pulmonary stenosis. The patient was managed for cyanotic spells and partial exchange transfusion was done for polycythemia. The patient started having fever spikes following exchange for which broad spectrum intravenous antibiotics were started. The hemogram showed raised counts with neutrophilia; however, blood and urine cultures were sterile. Urinalysis twice showed the presence of candida for which intravenous liposomal amphotericin B was added. FIG. 1 Contrast CT (CECT) abdominal scan showing bilateral perirenal fluid (white arrows) with scalloping of left kidney (white arrow head), thickened bilateral lateroconal fascia with pararenal fat stranding.