Urinothorax: Case report and systematic review of the literature

Abstract

Urinothorax, the presence of urine in the pleural space, is a rare cause of pleural effusion, usually associated with obstructive uropathy, or urinary trauma. We present the case of a 3 year-old boy and a systematic review of the literature of the 44 cases encountered. After resection of a Wilm's tumour in the right kidney our patient presented acute respiratory distress associated with radiographically confirmed pleural effusion. With the initial diagnosis of pneumonia or malignant pleural effusion, a closed thoracotomy was performed. The liquid obtained suggested urine, which was confirmed by the laboratory. Cystoscopy with retrograde pyelography detected a fistula on the posterior wall of the right kidney. The report of cases worldwide is low, probably due to its low incidence but also to underdiagnosis. Respiratory symptoms are not always present and urological symptoms usually predominate. Diagnosis requires a high degree of clinical suspicion and is confirmed by the main biochemical marker: The ratio >1.0 pleural fluid creatinine and creatinine serum.

Urinothorax: A rare complication of spontaneous bladder rupture

“…Following definitive repair, symptoms associated with UT typically rapidly improve. [9] As in our patient, she underwent cystoscopic repair followed by temporary urinary diversion with a foley catheter. Her symptoms rapidly improved with return of renal function to baseline and repeat imaging demonstrating resolution of UT and ascites.…”

Urinothorax, a rare complication of rupture renal calyx

“…If the pleural fluid analysis and the radiographic studies are inconsistent with the diagnosis but clinical suspicion remains high, renal scintigraphy can detect the migration of urine from the genitourinary tract into the pleural space. There are multiple cases in the literature that report the detection of urine translocation by using technetium-99m DTPA, technetium-99m ethylene dicysteine (EC) and technetium-99m-mercaptoacetyltriglycine-3 renal scintigraphy [6 , 9 , 10] .…”

“…Initial thoracocentesis may be helpful in relief of symptomatic dyspnea and prevention of infection, but the definitive treatment is to treat the cause. When the cause is treated, rapid resolution of the urinothorax occurs [4 , 10] .…”

Case report: Acute dyspnea secondary to urinothorax following ureteroscopy

“…Most cases of urinothorax arise secondary to obstructive uropathy or blunt abdominal trauma that either leads to disruption of the diaphragm or accumulation of urine in the retroperitoneum which subsequently leaks into the pleural space. 1 There are some known cases of nephropleural fistula after urologic interventions that have been diagnosed by contrast-enhanced CT Scans. 2 However, no fistulae were seen on CT in our case.…”

“…Most cases of urinothorax arise secondary to obstructive uropathy or blunt abdominal trauma that either leads to disruption of the diaphragm or accumulation of urine in the retroperitoneum which subsequently leaks into the pleural space. 1 Because of its rarity, we present this case to educate others to consider this diagnosis in patients who have recently undergone abdominal instrumentation.…”