Urinothorax, another complication of bladder tumor: case report

Abstract

Background Rupture of the fornix is a rare and serious urological complication of obstructive pathologies. The main cause is ureteral stone, but rarely a bladder tumor. Described complications of fornix rupture are superinfection, perirenal abscesses and even sepsis, but not urinothorax. Case presentation Patient of 56 years old, active and chronic smoker, was hospitalized for anemia and obstructive renal failure on a non-documented bladder tumor; clinically, he was presented with hematuria and an intense right loin pain associated with homolateral basithoracic pain and dyspnea. The CT scan without injection showed a right perirenal collection with bilateral renal dilatation on endo-vesical tumor and a right pleural effusion of less abundance. The ratio of pleural fluid creatinine to blood creatinine was greater than 1, confirming urinothorax. As an emergency, a percutaneous nephrostomy was performed. After clinical stabilization, the patient underwent a trans-urethral resection of the bladder and derivation by a double j stent. The ultimate evolution was favorable. Conclusions Beyond the metabolic complications secondary to obstructions, mechanical complications, which can also be fatal, must be included.