Skeletal Radiology

, Volume 48, Issue 3, pp 461–465 | Cite as

Case report: urinoma in the proximal thigh mimicking a soft tissue neoplasm

  • Christopher Schuppert
  • Christoph Rehnitz
  • Carine Pecqueux
  • Michaela Angelescu
  • Christopher L. SchlettEmail author
Case Report


Soft tissue tumors form a heterogeneous group of benign and malignant lesions. Those with a high fluid content may be particularly challenging in diagnosis. We present a 78-year-old man with a dolorous, progressive mass in the adductor region of the lower left extremity. At the end of a long diagnostic pathway, the pseudocystic tumor was eventually identified as a urinoma, caused by a prostatosymphyseal fistula that had occurred as a late complication of transurethral resection of the prostate. Our finding represents a rare variant of soft tissue tumors in the lower extremities, which MR-based urography can help to reveal.


Tumor Myxoid Urinoma TURP PSF Complication MR urography 


Compliance with ethical standards

Conflict of interest



  1. 1.
    Fletcher CDM, Unni KK, Mertens F, Organization WH, Pathology IAo. Pathology and Genetics of Tumours of Soft Tissue and Bone: IARC Press, 2002.Google Scholar
  2. 2.
    Ferrari A, Sultan I, Huang TT, Rodriguez-Galindo C, Shehadeh A, Meazza C, et al. Soft tissue sarcoma across the age spectrum: a population-based study from the surveillance epidemiology and end results database. Pediatr Blood Cancer. 2011;57(6):943–9.CrossRefGoogle Scholar
  3. 3.
    Ng VY, Scharschmidt TJ, Mayerson JL, Fisher JL. Incidence and survival in sarcoma in the United States: a focus on musculoskeletal lesions. Anticancer Res. 2013;33(6):2597–604.PubMedGoogle Scholar
  4. 4.
    Kransdorf MJ. Malignant soft-tissue tumors in a large referral population: distribution of diagnoses by age, sex, and location. AJR Am J Roentgenol. 1995;164(1):129–34.CrossRefGoogle Scholar
  5. 5.
    Mathew R, Kaveriappa G, Shetty M, Suresh H. Subcutaneous urinoma: a rare sequelae to percutaneous nephrolithotomy. Muller J Med Sci Res. 2015;6(1):78–80.CrossRefGoogle Scholar
  6. 6.
    Lee J, Darcy M. Renal cysts and urinomas. Semin Interv Radiol. 2011;28(4):380–91.CrossRefGoogle Scholar
  7. 7.
    Titton RL, Gervais DA, Hahn PF, Harisinghani MG, Arellano RS, Mueller PR. Urine leaks and urinomas: diagnosis and imaging-guided intervention. Radiographics. 2003;23(5):1133–47.CrossRefGoogle Scholar
  8. 8.
    Plateau B, Ruivard M, Montoriol PF. Prostatosymphyseal fistula and osteomyelitis pubis following transurethral resection of the prostate: CT and MRI findings. J Med Imaging Radiat Oncol. 2015;59(6):713–5.CrossRefGoogle Scholar
  9. 9.
    Elshout PJ, Verleyen P, Putzeys G. Osteitis pubis after TURP: a rare complication difficult to recognize. Urol Case Rep. 2016;4:55–6.CrossRefGoogle Scholar
  10. 10.
    Kats E, Venema PL, Kropman RF. A rare complication after endoscopic resection of the prostate: osteitis pubis due to a prostate-symphysis fistula. J Urol. 1997;157(2):624.CrossRefGoogle Scholar
  11. 11.
    Gillitzer R, Melchior SW, Jones J, Fichtner J, Thuroff JW. Prostatosymphyseal fistula after transurethral resection of the prostate. J Urol. 2001;166(3):1001–2.CrossRefGoogle Scholar
  12. 12.
    Wolf RF, Elzen AH, de Jong IJ. Homan van der Heide JN, Jager PL, Boeve WJ. [Giant urinoma of the thigh]. Ned Tijdschr Geneeskd. 1998;142(16):908–12.PubMedGoogle Scholar
  13. 13.
    Kats E, Venema PL, Kropman RF, Kieft GJ. Diagnosis and treatment of osteitis pubis caused by a prostate-symphysis fistula: a rare complication after transurethral resection of the prostate. Br J Urol. 1998;81(6):927–8.CrossRefGoogle Scholar
  14. 14.
    Schneider T, Bach D, Rübben H. Das Urinom des Oberschenkels. Der Urologe B. 1999;39(6):505–7.CrossRefGoogle Scholar
  15. 15.
    Bugeja S, Andrich DE, Mundy AR. Fistulation into the pubic symphysis after treatment of prostate cancer: an important and surgically correctable complication. J Urol. 2016; 195(2):391–398%@ 0022–5347.Google Scholar
  16. 16.
    Sanchez A, Rodriguez D, Cheng JS, McGovern FJ, Tabatabaei S. Prostato-symphyseal fistula after photoselective vaporization of the prostate: case series and literature review of a rare complication. Urology. 2015;85(1):172–7.CrossRefGoogle Scholar
  17. 17.
    Ma LD, McCarthy EF, Bluemke DA, Frassica FJ. Differentiation of benign from malignant musculoskeletal lesions using MR imaging: pitfalls in MR evaluation of lesions with a cystic appearance. AJR Am J Roentgenol. 1998;170(5):1251–8.CrossRefGoogle Scholar
  18. 18.
    Cox JA, Bartlett E, Lee EI. Vascular malformations: a review. Semin Plast Surg. 2014;28(2):58–63.CrossRefGoogle Scholar
  19. 19.
    Sepulveda A, Buchanan EP. Vascular tumors. Semin Plast Surg. 2014;28(2):49–57.CrossRefGoogle Scholar
  20. 20.
    Willems SM, Schrage YM, Baelde JJ, Briaire-de Bruijn I, Mohseny A, Sciot R, et al. Myxoid tumours of soft tissue: the so-called myxoid extracellular matrix is heterogeneous in composition. Histopathology. 2008;52(4):465–74.CrossRefGoogle Scholar
  21. 21.
    Kindblom LG, Angervall L. Histochemical characterization of mucosubstances in bone and soft tissue-tumors. Cancer. 1975;36(3):985–94.CrossRefGoogle Scholar
  22. 22.
    Willems SM, Wiweger M, van Roggen JF, Hogendoorn PC. Running GAGs: myxoid matrix in tumor pathology revisited: what’s in it for the pathologist? Virchows Archiv: Int J Pathol. 2010;456(2):181–92.CrossRefGoogle Scholar

Copyright information

© ISS 2018

Authors and Affiliations

  • Christopher Schuppert
    • 1
  • Christoph Rehnitz
    • 1
  • Carine Pecqueux
    • 2
  • Michaela Angelescu
    • 3
  • Christopher L. Schlett
    • 1
    Email author
  1. 1.Department of Diagnostic and Interventional RadiologyHeidelberg University HospitalHeidelbergGermany
  2. 2.Department of UrologyHeidelberg University HospitalHeidelbergGermany
  3. 3.Department of General, Visceral and Transplantation SurgeryHeidelberg University HospitalHeidelbergGermany

Personalised recommendations