The authors illustrate through an observation of an aggressive and exceptional pleural evolution metastatic of a carcinoma urothelial of the upper urinary tract at the origin of an atypical radiological aspect and rarely described of pseudo-mesothelioma. In our case, the instillation with the BCG Pasteur by the percutaneous nephrostomy and the pleur X with the profit of a heavy chemotherapy enabled us to in fact circumvent the evolution towards the acute complications related to this pathology, the malignant pleuresis.Keywords: BCG; Chemotherapy; Differential diagnosis; Mesothelioma; Radiotherapy; Surgery; Urothelial carcinomaThe authors describe here the first Malagasy case of urothelial carcinoma of the upper urinary tract radiological discovery late in pleural metastatic and discuss differential diagnoses of the image and the evolution of this tumor treated with topical agent adjuvant through review of recent literature. ObservationMr RAV. 53 years old, no smoking was hospitalized for progressive worsening of dyspnea lasting for 6 months, accompanied by chest pain basi-left. In the interview we noted a notion regularly taking a decoction of clinical médicinales. L'examen virtues plants entering found an alteration of the general status (PS = 3 according to WHO), a left pulmonary syndrome without condensation fever. Radiography of thorax face showed pleural thickening picture left scalloped. Chest CT (Figure 1) confirmed the pleural lesions secondary look and abdominopelvic CT scan for staging (Figure 2) found a retroperitoneal mass compatible of renal tumor primitive right. Biologically, there was a LDH assay was raised to 1423 IU/ml (5 times normal). Histological examination of a biopsy transthoracic puncture confirmed the location of a secondary urothelial carcinoma at the pleura (pT4N2M1) (Figure 3). Our patient had received a course of BCG instillation Pasteur by percutaneous nephrostomy and the tear-X (thoracic drainage system) and died after three months of decline following the natural evolution of the tumor.