This case describes a 70-year-old female who presented with right flank pain around the site where a stent had been placed in her right kidney at an outside hospital several months earlier. The patient arrived tachycardic with a leukocytosis and a lactic acidosis. Further imaging revealed a very hydronephrotic right kidney and an extremely large fluid collection in the right retroperitoneum extending into the right flank consistent with leakage of urine from the obstructed right kidney. Prompt treatment of this rare phenomenon is crucial for delay in medical care can lead to abscess, hydronephrosis, electrolyte instability, and a progressive loss of renal function. Treatment for small urinomas is usually conservative as the collection will most often be reabsorbed. Larger urinomas even without systemic signs often necessitate more aggressive medical treatment. A drainage catheter can be placed with ultrasound or CT guidance. Percutaneous nephrostomy tubes are often used as well for additional drainage and decompression. Fluid culture is recommended to guide antibiotic treatment.

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Purpose of the study: The purpose of this study was to determine if participant emergency residents were to correctly identify a disposable stethoscope versus a standard stethoscope and also whether participants were able to identify a gloved standard stethoscope versus an ungloved standard stethoscope. Materials and Methods: The setting was the three emergency departments of a community-based, university-affiliated hospital system. The study was approved by the Institutional Review Board. The participants were residents in emergency medicine. They were asked to perform a first-pass assessment to determine if they could correctly could detect whether they were listening to volunteer resident lung sounds through a standard or a disposable stethoscope. Participants consented to the study. The subject will not be requested to identify the nature of the sounds. They were also asked to determine if they could detect whether a nitrile glove was, or was not, placed on a stethoscope. Thus, the practitioner's ears, blinded visually to the presence or absence of the glove, would provide the first-pass assessment of the effect of nitrile gloves on acoustic performance on volunteer normal participants.All participants consented to the study. Results: 12 participants were able to correctly identify the disposable stethoscope (57%). Nine (9) participants could not (43%) The difference between the correct and incorrect identification was not statistically significant (p=0.37). Only 14% of participants were able to identify the gloved stethoscope. 86% of participants thought that the gloved stethoscope was a superior sound and that it was ungloved. Further research could confirm these findings.