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[This retracts the article DOI: 10.7759/cureus.19878.].
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[This retracts the article DOI: 10.7759/cureus.19763.].
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[This retracts the article DOI: 10.7759/cureus.19752.].
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Urinary stone disease is a common problem globally. Ureteric colic typically presents with flank pain and hematuria. However, several conditions may give a similar clinical picture. Hence, imaging studies are essential to make the diagnosis of urinary stone disease and evaluate for possible complications. We present the case of a 64-year-old man who presented with severe left flank pain radiating to the groin for two days. In his first visit to the emergency department, he was prescribed conservative treatment, but it failed to give any clinical improvement. The patient does not have a previous history of urinary stone disease. He had a long-standing history of hypertension, diabetes mellitus, dyslipidemia, and coronary artery disease. Further, he had a 30 pack-years history of smoking. Upon examination, the abdomen was soft and lax with generalized tenderness. Subsequently, a non-contrast computed tomography scan for the kidneys, ureters, and bladder was performed, which demonstrated a large high attenuation fluid seen in the left side of the retroperitoneum. The scan was then repeated after the administration of intravenous contrast and showed an aneurysmal dilatation of the left common iliac artery with surrounding hematoma. The patient was taken for an emergency laparotomy for evacuation of the hematoma and graft repair of the aneurysm. The patient tolerated the operation without complications. The present case highlights the importance of considering the wide differential diagnoses of flank pain in emergency settings. Physicians should keep a high index of suspicion for aneurysmal disease when they encounter patients with risk factors for arterial wall degeneration.
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The coronavirus disease 2019 (COVID-19) may have multisystem organ involvement. Thrombotic events are well-recognized complications of COVID-19. Such complications may include the pulmonary, renal, and other organs vasculature. The risk of coagulopathy is usually related to the severity of COVID-19 pneumonia. Few cases suggested that the coagulopathy risk may persist for some period after the recovery from COVID-19. We report the case of a middle-aged man with severe COVID-19 pneumonia that required seven days of endotracheal intubation and mechanical ventilation who presented with headache and left-sided weakness that occurred three days after his discharge. A computed tomography scan was performed to rule out intracranial hemorrhage before initiating the thrombolytic therapy. The scan demonstrated hemorrhage in the right temporal lobe with surrounding vasogenic edema along with density in the right transverse sinus. Subsequently, computed tomography venography was performed and demonstrated the filling defect representing right sigmoid venous sinus thrombosis. The patient received conservative measures in the form of intravenous hydration, anticoagulation, analgesics, and anticonvulsants. During the hospital stay, the patient had improvement in his symptom and mild neurological deficit persisted. The case highlighted that risk of thrombotic complications in COVID-19 pneumonia may persist for some period after the recovery from the disease. Hence, thromboprophylaxis may be indicated in selected patients with a risk of thrombotic events after their recovery from severe COVID-19.
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Urge incontinence is the most frequent type of urinary incontinence that can be due to bladder outlet obstruction or overactive bladder. A focused history is crucial to identify the type of urinary incontinence and the possible etiology. We report the case of a 67-year-old man with urinary frequency, urgency, and nocturia. However, his urine stream is normal with no history of an intermittent stream, hesitancy, or postvoid dribbling. Digital rectal examination revealed normal prostatic size. Urinalysis results were normal. Urine culture showed no growth. The patient was prescribed symptomatic treatment in the form of anticholinergic medication but failed to provide any clinical improvement. Urodynamic studies suggested the diagnosis of detrusor instability. A computed tomography (CT) scan of the abdomen was performed and demonstrated the presence of a large retroperitoneal lipoma exerting a mass effect on the bladder. The mass was successfully resected by laparotomy operation. Following the operation, the patient had complete resolution of his symptoms. The retroperitoneal region is an extremely rare site for lipoma. Patients with urinary urgency should be carefully evaluated for any structural lesion causing a compressive effect on the bladder.