Case of urinothorax - A rare presentation

Right perirenal urinoma and urinothorax in an infant after neonatal ablation of posterior urethral valve: A rare complication diagnosed by pleural aspiration and treated with perinephric drainage: a case report

OBJECTIVE

Urinothorax and urinoma are rare complications of obstructive uropathy. They might occur due to persistent high back pressure on the renal parenchyma. Urinothorax usually arises while the obstruction exists; in contrast to our case, the child presented after being operated on. He had falsely high creatinine before the operation, which was later explained by creatinine recirculation.

CLINICAL PRESENTATION AND INTERVENTION

We are reporting an uncommon case of late presentation of ruptured urinoma in a 2-month-old Kuwaiti male. It led to urinothorax/uroperitoneum that caused respiratory distress and was associated with creatinine recirculation, requiring retroperitoneal perinephric catheter insertion. The child had recovered and was discharged home.

CONCLUSION

A high index of suspicion is required to diagnose urinothorax, especially in patients with a history of obstructive uropathy. Aspiration of the pleural effusion will guide you to reach the diagnosis. Creatinine recirculation is rarely described in the literature. Having a patient with urinothorax/uroperitoneum should raise the suspicion of falsely elevated creatinine levels.

Urine in the lung: An uncommon cause of transudative pleural effusion

Urinothorax [UT], the accumulation of urine in the pleural space, is an uncommon cause of pleural effusions resulting from trauma, obstruction, or iatrogenic causes. Thoracentesis with pleural fluid analysis and evaluation of biochemical characteristics, such as pleural fluid creatinine (PCr) to serum creatinine ratio (Scr), is necessary to establish this diagnosis. This case illustrates a 93 year old man with a complicated past medical history including chronic kidney disease stage 4, adenocarcinoma of the prostate status post brachytherapy complicated by proctitis, high grade transitional cell carcinoma of the right kidney with right hydronephrosis, and recurrent hematuria who was hospitalized for worsening hematuria and suprapubic pain. The patients CXR showed a large right pleural effusion. A repeat thoracentesis was performed removing 1.85L clear yellow fluid. PCr and SCr were 4.1 mg/dl and 3.94 mg/dL respectively. This confirmed the diagnosis of UT with a PCr to SCr ratio of 1.04. Again, diagnosis requires pleural fluid analysis and is associated with a paucicellular, transudative effusion with an ammonia-like odor, acidotic pH less than 7.4, and a PCr to SCr ratio greater than 1.0. Management is dependent on correcting the underlying pathology, such as repairing traumatic GU injury or obstruction.