1
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Battah A, Farouji A, DaCosta T, Ahmad A, Kazmi R, DaCosta T, Miller R, Farouji I. Urinothorax, a rare complication of rupture renal calyx. Radiol Case Rep 2023; 18:2335-2338. [PMID: 37179801 PMCID: PMC10172621 DOI: 10.1016/j.radcr.2023.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 05/15/2023] Open
Abstract
Urinothorax is one of the rare causes of pleural effusion of extra-vascular origin, commonly presents with a transudative pleural effusion due to obstruction, injury or trauma to the genitourinary tract. It is not a common cause which increases the likelihood of underdiagnosis or misdiagnosis. Herein, we are presenting a 65-year-old gentleman who presented with urinary symptoms found to have urinothorax secondary to urinary tract obstruction by benign prostatic hypertrophy. This case was further complicated by urinoma and pyelonephritis. We are reporting this case to highlight the importance of including this entity in the differential diagnosis in patients who have pleural effusion especially if they presented with obstructive urinary symptoms.
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Affiliation(s)
- Arwa Battah
- Department of Internal Medicine, Saint Michael's Medical Center, New York Medical College, Newark, NJ USA
| | - Abdelhadi Farouji
- Department of Internal Medicine, Saint Michael's Medical Center, New York Medical College, Newark, NJ USA
| | - Theodore DaCosta
- Department of Internal Medicine, Saint Michael's Medical Center, New York Medical College, Newark, NJ USA
| | - Amaar Ahmad
- Department of Internal Medicine, Saint Michael's Medical Center, New York Medical College, Newark, NJ USA
| | - Riyashat Kazmi
- Department of Internal Medicine, Saint Michael's Medical Center, New York Medical College, Newark, NJ USA
| | - Theodore DaCosta
- Department of Internal Medicine, Saint Michael's Medical Center, New York Medical College, Newark, NJ USA
| | - Richardb Miller
- Department of Pulmonology, Saint Michael's Medical Center, New York Medical College, 111 Central Ave, Newark, NJ, 07102, USA
| | - Iyad Farouji
- Department of Pulmonology, Saint Michael's Medical Center, New York Medical College, 111 Central Ave, Newark, NJ, 07102, USA
- Department of Cardiology, Saint Michael's Medical Center, New York Medical College, Newark, NJ, USA
- Corresponding author.
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2
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Jaber JF, Rosier L, Sykes JJ, Asharaf A, Trillo C, Austin A. Malpositioned nephrostomy tube with associated hemorrhagic pleural effusion. Respir Med Case Rep 2022; 41:101798. [PMID: 36583059 PMCID: PMC9793309 DOI: 10.1016/j.rmcr.2022.101798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/05/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Pleural effusion of extra-vascular origin has a large differential diagnosis. Ultrasonography can be utilized alongside pleural fluid analysis to determine a pleural effusion's complexity and size, thus helping aid in both diagnostic and therapeutic management. We describe the case of a 38-year-old male with a prior medical history of neurogenic bladder and nephrolithiasis with percutaneous nephrostomy tube placed one week prior to presentation. Using ultrasonography, the nephrostomy tube was determined to be positioned within the pleural cavity with a resultant hemorrhagic pleural effusion.
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Affiliation(s)
- Johnny F. Jaber
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville, FL, 32608, United States,Corresponding author. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32608, United States.
| | - Luderve Rosier
- University of Florida College of Medicine, Gainesville, FL, 32608, United States
| | - John J. Sykes
- University of Florida College of Medicine, Gainesville, FL, 32608, United States
| | - Afsana Asharaf
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville, FL, 32608, United States
| | - Cesar Trillo
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville, FL, 32608, United States
| | - Adam Austin
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida College of Medicine, Gainesville, FL, 32608, United States
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3
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Pérez-Palenzuela J, Sosa-Martín JG, Pérez-García K, Martínez-García A, Díaz-Calderín JM. Urinothorax: rare complication of percutaneous nephrolithotomy. Case report. CIR CIR 2021; 89:17-21. [PMID: 34932528 DOI: 10.24875/ciru.21000008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Urinothorax is an unusual cause of pleural effusion. To describe a case with urinothorax secondary to urinary system trauma. 41-year-old male readmitted to our hospital 16 days after a right percutaneous nephrolithotomy with fever, shortness of breath, chest pain and multiloculated pleural effusion confirmed by CT scan, resolved with surgical treatment. Readmitted twenty-one days later with recurrent empyema and diagnosis of reno-pleural fistula, treated with new thoracotomy and double J and urinary catheter placement. The suspected diagnosis and the multidisciplinary approach allowed to solve this rare complication.
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Affiliation(s)
- Javier Pérez-Palenzuela
- Servicio de Cirugía General, Hospital Clínico Quirúrgico Hermanos Ameijeiras, Universidad de Ciencias Médicas de la Habana, La Habana, Cuba
| | - José G Sosa-Martín
- Servicio de Cirugía General, Hospital Clínico Quirúrgico Hermanos Ameijeiras, Universidad de Ciencias Médicas de la Habana, La Habana, Cuba
| | - Kymani Pérez-García
- Servicio de Cirugía General, Hospital Clínico Quirúrgico Hermanos Ameijeiras, Universidad de Ciencias Médicas de la Habana, La Habana, Cuba
| | - Arturo Martínez-García
- Servicio de Cirugía General, Hospital Clínico Quirúrgico Hermanos Ameijeiras, Universidad de Ciencias Médicas de la Habana, La Habana, Cuba
| | - José M Díaz-Calderín
- Servicio de Cirugía General, Hospital Clínico Quirúrgico Hermanos Ameijeiras, Universidad de Ciencias Médicas de la Habana, La Habana, Cuba
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4
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Chen YH, Chen M, Chen YH. Intrathoracic ureteric stent migration through a reno-pleural fistula: a case report of rare antegrade ureteric stenting complication. BMC Womens Health 2021; 21:270. [PMID: 34246259 PMCID: PMC8272335 DOI: 10.1186/s12905-021-01405-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/28/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Malignant obstruction and associated hydronephrosis is a common complication of advanced cervical cancer. Percutaneous nephrostomy (PCN) followed by antegrade stenting is often required to relieve obstruction as retrograde access fails in considerable proportion of such patients. Reno-pleural fistula is a rare complication of PCN which creates a patent connection between the renal collecting system and the thoracic cavity, and urine accumulation in the pleural space can cause pleural effusion (i.e., urinothorax). Upward or downward migration is a complication of indwelling ureteric stents. Further migration with extrusion outside of the urinary tract is uncommon. Herein we present an unprecedented case in adult of ureteric stent upward migration through a reno-pleural fistula into the thoracic cavity managed by thoracoscopy. CASE PRESENTATION A 66-year-old female was diagnosed of advanced stage cervical cancer with suspicious bladder invasion. Given her bilateral hydronephrosis with impaired renal function, she underwent bilateral PCN and subsequent antegrade ureteric stenting. However, she presented with dyspnea, right back pain, and oliguria four days after bilateral PCN catheter removal. Computed tomography reported massive right pleural effusion and an intrathoracic ureteric stent within reno-pleural fistula. Thoracoscopy with thoracostomy was performed to remove the ureteric stent and urine in right pleural space. A week later, urinothorax had resolved and right PCN was performed again. She was discharged after regaining normal renal function with right PCN and a left ureteric stent in place. CONCLUSIONS A reno-pleural fistula can serve as a route for ureteric stent migration and that continuous drainage of urine can cause urinothorax once the stent reaches the thoracic cavity. Anytime a supracostal approach is used for PCN, even when using small caliber catheters, clinicians should pay special attention given the risk of pleural injury and subsequent complications.
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Affiliation(s)
- Yi-Hsuan Chen
- Department of Urology, Mackay Memorial Hospital, Zhongshan Dist, No. 92, Sec. 2, Zhongshan N. Rd, Taipei, 104, Taiwan
| | - Marcelo Chen
- Department of Urology, Mackay Memorial Hospital, Zhongshan Dist, No. 92, Sec. 2, Zhongshan N. Rd, Taipei, 104, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Yu-Hsin Chen
- Department of Urology, Mackay Memorial Hospital, Zhongshan Dist, No. 92, Sec. 2, Zhongshan N. Rd, Taipei, 104, Taiwan. .,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan. .,Institute of Pharmacology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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5
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Malaga-Dieguez L, Trachtman H, Giusti R. Pulmonary Manifestations of Renal Disorders in Children. Pediatr Clin North Am 2021; 68:209-222. [PMID: 33228933 DOI: 10.1016/j.pcl.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The causes of kidney disease in pediatric patients are evenly divided between congenital abnormalities of the kidney and urinary tract and acquired disorders. Nearly 10% to 15% of adults in the United States have chronic kidney disease (CKD); there are no comparable data in children. Regardless of patient age, CKD is a systemic problem that affects every organ system, including the lung. We review the tests used to diagnose and evaluate kidney disease and the main clinical syndromes that are likely to be encountered to aid the pulmonology consultant who is asked to evaluate patients with kidney disease.
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Affiliation(s)
- Laura Malaga-Dieguez
- Division of Pediatric Nephrology, Department of Pediatrics, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, 550 First Avenue, New York, NY 10016, USA.
| | - Howard Trachtman
- Division of Pediatric Nephrology, Department of Pediatrics, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, 550 First Avenue, New York, NY 10016, USA
| | - Robert Giusti
- Division of Pediatric Pulmonology, Department of Pediatrics, NYU School of Medicine, Hassenfeld Children's Hospital at NYU Langone, 550 First Avenue, New York, NY 10016, USA
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Ng H, Wang K, Cartledge J, Biyani CS, Ralph C, Jagdev S, Vasudev N, Bhattarai S, Bhartia B, Lenton J, Smith J, Whiteley S, Tcherveniakov P, Wah TM. Urinothorax following percutaneous image-guided renal cryoablation. Radiol Case Rep 2020; 15:2348-52. [PMID: 32994839 DOI: 10.1016/j.radcr.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/05/2022] Open
Abstract
A 69-year-old lady with 2 renal cell carcinomas, one sited at the upper pole of her solitary right kidney, underwent percutaneous image-guided cryoablation and developed urinothorax as a complication. This was diagnosed from pleural fluid analysis and radiology imaging with computed tomography (CT). Management included image-guided chest drain and retrograde ureteric stent insertion to divert the urine from entering the pleural cavity. CT images demonstrated a fistula between the site of renal puncture and the pleural cavity, indicating that the cryoprobes traversed the diaphragm during the procedure. This case highlights urinothorax as an unusual complication of cryoablation of renal cell carcinoma. Prompt diagnosis by interventional radiologists is crucial to avert from this potentially life-threatening complication.
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7
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Tsao RY, Duong T, Brewster JB, Khaja MS, Prahlow JA. Death due to atypical urinothorax following percutaneous nephrolithotomy. Forensic Sci Med Pathol 2020; 16:321-324. [PMID: 32323187 DOI: 10.1007/s12024-020-00244-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Abstract
Urinothorax is a cause of pleural effusion that is often missed due to its perceived rarity. Here, we present a case of urinothorax secondary to percutaneous nephrolithotomy resulting in lung collapse and death. This case highlights urinothorax as a cause of death, its biochemical profile, and diagnostic features on autopsy. A 39-year-old female presented to the ED with low back pain and dysuria. Abdominal and pelvic CT showed a large staghorn calculus in the right kidney which was then treated with percutaneous nephrolithotomy. On post-operative day (POD) 1, the patient was febrile, had decreased breath sounds, and complained of pain with deep inspiration. Chest x-ray revealed increased right pleural fluid. On POD 3, the patient continued to have difficulty breathing and was eventually found apneic. Resuscitation was unsuccessful. Autopsy revealed a collapsed right lung associated with a 1200 mL pleural effusion, which was cloudy, yellow, and smelled like urine. The cause of death was listed as complications of percutaneous nephrolitotomy, with urinothorax and collapse of lung. While rare, urinothoraces must be considered as a cause of pleural effusion due to risk of respiratory failure and death. Diagnosis relies on pleural fluid analysis and history, especially with regard to genitourinary obstruction and surgeries.
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Affiliation(s)
- Ray-Young Tsao
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Thomas Duong
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA.
| | | | - Minhaj S Khaja
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Joseph A Prahlow
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
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8
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Bahjat AS, Sadeeq KJ, Tahir AMS, Mohammed AA. Urinothorax causing massive left side pleural effusion in a young lady; case report and literature review. Urol Case Rep 2019; 26:100957. [PMID: 31321210 PMCID: PMC6612650 DOI: 10.1016/j.eucr.2019.100957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 11/29/2022] Open
Abstract
Urinothorax is the presence of the urine in the pleural space. This condition is very rare and occurs due to unrelieved obstruction of urinary flow. A 20-year-old female presented 7 days after cesarean section with tachypnea, and generalized abdominal pain. There was absent air entry over the left hemithorax. CT scan showed massive left pleural effusion and a stone obstructing the renal pelvis with hydronephrosis and peri-renal collection. The pleural fluid had high fluid creatinine level suggesting urine collection. Ureteroscopy done and double J catheter inserted. The effusion became loculated, thoracotomy and pleural decortication done.
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Affiliation(s)
- Alaa S. Bahjat
- University of Duhok, College of Medicine, Department of Surgery, Duhok City, Kurdistan Region, Iraq
| | - Kamiran J. Sadeeq
- University of Duhok, College of Medicine, Department of Surgery, Duhok City, Kurdistan Region, Iraq
| | | | - Ayad Ahmad Mohammed
- University of Duhok, College of Medicine, Department of Surgery, Duhok City, Kurdistan Region, Iraq
- Corresponding author. University of Duhok, College of Medicine, Department of Surgery, Azadi Teaching Hospital, 8 Nakhoshkhana Road, 1014, AM, Duhok City, DUHOK, Kurdistan Region, Iraq.
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9
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Vallianou N, Gennimata V, Constantinou F, Karamanolakis D, Grigorakis A. Synchronous urinothorax and uroperitoneum. Am J Emerg Med 2018; 36:1922.e1-1922.e2. [PMID: 29914713 DOI: 10.1016/j.ajem.2018.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 10/14/2022] Open
Abstract
Urinothorax was first described in 1968 by Corriere et al. as the presence of urine in the pleural cavity due to retroperitoneal leakage of accumulated urine. Herein, we present a female patient, who complained of dyspnea due to urinothorax. This is the first case of urinothorax that developed so tardive after radiotherapy and was diagnosed due to high clinical evidence despite the negative scintigraphy.
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Affiliation(s)
- Natalia Vallianou
- Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece.
| | - Victoria Gennimata
- Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece
| | - Fotis Constantinou
- Department of Internal Medicine, Evangelismos General Hospital, Athens, Greece
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10
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Vergne F, Le Mao R, Simonin L, Descourt R, Couturaud F, Barnier A, Tromeur C. [A very unusual pleural presentation]. Rev Mal Respir 2018; 35:567-570. [PMID: 29778619 DOI: 10.1016/j.rmr.2017.10.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 10/26/2017] [Indexed: 10/16/2022]
Abstract
Urinothorax refers to the presence of urine in the pleural space. Urinothorax is an infrequent and underdiagnosed pathology, with few cases reported, and these often suspected only with hindsight. It is usually a transudative pleural effusion. We report a case of urinothorax presenting as a purulent pleural effusion. Management of the urinothorax required antibiotics and surgical unblocking of the urinary tract. Currently, no test is available to confirm the diagnosis. The ratio of serum creatinine/pleural creatinine could suggest the presence of urinothorax but this parameter needs to be validated by complementary studies. Urinothorax should be suspected in the context of pleural effusion occurring after a recent urologic surgery.
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Affiliation(s)
- F Vergne
- Service de pneumologie, hôpital la Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
| | - R Le Mao
- Service de pneumologie, hôpital la Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
| | - L Simonin
- Service de pneumologie, hôpital la Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
| | - R Descourt
- Service de pneumologie, hôpital la Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
| | - F Couturaud
- Service de pneumologie, hôpital la Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France; EA3878, CIC-Inserm 1412, hôpital de la Cavale-Blanche, CHRU de Brest, 29200 Brest, France
| | - A Barnier
- Service de pneumologie, hôpital la Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France; EA3878, CIC-Inserm 1412, hôpital de la Cavale-Blanche, CHRU de Brest, 29200 Brest, France
| | - C Tromeur
- Service de pneumologie, hôpital la Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France; EA3878, CIC-Inserm 1412, hôpital de la Cavale-Blanche, CHRU de Brest, 29200 Brest, France.
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11
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Lee TW, Jang HN, Cho HS, Choi SM, Choi BH, Bae E, Chang SH, Park DJ. Urinothorax after ultrasonography-guided renal biopsy: a case report. BMC Nephrol 2018; 19:104. [PMID: 29724179 PMCID: PMC5934790 DOI: 10.1186/s12882-018-0903-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urinothorax is defined as the presence of urine in the pleural space and is a rather rare cause of transudate pleural effusion. The potential etiologies are urinary tract obstruction and trauma. Diagnosis requires a high index of clinical suspicion and the condition is completely reversible following relief of underlying disease. CASE PRESENTATION We report a 27-year-old man who developed urinothorax after renal biopsy. Urine leakage was confirmed with 99mTc DTPA (diethylenetriaminepentacetate) and single-photon emission computed tomography scans and retrograde pyelography. The pleural effusion was completely resolved by removing the leakage with a Foley catheter and a double J stent. CONCLUSIONS Urinothorax has not been reported in patients doing renal biopsy in the literature. Based on our experience, urinothorax should be suspected, diagnosed, and managed appropriately when pleural effusion occurred after renal biopsy.
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Affiliation(s)
- Tae Won Lee
- Department of Internal Medicine, Changwon Gyeongsang National University Hospital, 11, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, South Korea
| | - Ha Nee Jang
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hyun Seop Cho
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - See Min Choi
- Department of Urology, Gyeongsang National University Hospital, Jinju, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University School of Medicine, 90, Chiram-dong, Jinju-si, Gyeongsangnam-do, South Korea
| | - Bong-Hoi Choi
- Department of Nuclear and Molecular imaging, Gyeongsang National University Hospital, Jinju, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University School of Medicine, 90, Chiram-dong, Jinju-si, Gyeongsangnam-do, South Korea
| | - Eunjin Bae
- Department of Internal Medicine, Changwon Gyeongsang National University Hospital, 11, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, South Korea
| | - Se-Ho Chang
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.,Department of Internal Medicine, Gyeongsang National University School of Medicine, 90, Chiram-dong, Jinju-si, Gyeongsangnam-do, South Korea.,Institute of Health Science, Gyeongsang National University, Jinju, Republic of Korea
| | - Dong Jun Park
- Department of Internal Medicine, Changwon Gyeongsang National University Hospital, 11, Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do, South Korea. .,Department of Internal Medicine, Gyeongsang National University School of Medicine, 90, Chiram-dong, Jinju-si, Gyeongsangnam-do, South Korea. .,Institute of Health Science, Gyeongsang National University, Jinju, Republic of Korea.
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12
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Austin A, Jogani SN, Brasher PB, Argula RG, Huggins JT, Chopra A. The Urinothorax: A Comprehensive Review With Case Series. Am J Med Sci 2017; 354:44-53. [PMID: 28755732 DOI: 10.1016/j.amjms.2017.03.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/17/2017] [Accepted: 03/29/2017] [Indexed: 01/08/2023]
Abstract
Urinothorax is an uncommon thoracic complication of genitourinary (GU) tract disease, which is most frequently caused by obstructive uropathy, but may also occur as a result of iatrogenic or traumatic GU injury. It is underrecognized because of a perceived notion as to the rarity of the diagnosis and the absence of established diagnostic criteria. Urinothorax is typically described as a paucicellular, transudative pleural effusion with a pleural fluid/serum creatinine ratio >1.0. It is the only transudate associated with pleural fluid acidosis (pH < 7.40). When the pleural fluid analysis demonstrates features of a transudate, pH <7.40 and a pleural fluid/serum creatinine ratio >1.0, a confident clinical diagnosis of urinothorax can be established. A technetium 99m renal scan can be considered a confirmatory test in patients who lack the typical pleural fluid analysis features or fail to demonstrate evidence of obstructive uropathy that can be identified via conventional radiographic modalities. Management of a urinothorax requires a multidisciplinary approach with an emphasis on the correction of the underlying GU tract pathology, and once corrected, this often leads to a rapid resolution of the pleural effusion.
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Affiliation(s)
- Adam Austin
- Department of Medicine, Albany Medical College, Albany, New York.
| | - Sidharth Navin Jogani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, Albany, New York
| | - Paul Bradley Brasher
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Rahul Gupta Argula
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - John Terrill Huggins
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Amit Chopra
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, Albany, New York
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13
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Chan DMK, Cheung VYT. Urinothorax as an early sign of urinary tract injury following total laparoscopic hysterectomy. Int J Gynaecol Obstet 2016; 134:102-3. [PMID: 26972182 DOI: 10.1016/j.ijgo.2015.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 11/19/2015] [Accepted: 02/17/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Diana M K Chan
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Vincent Y T Cheung
- Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
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14
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Batura D, Haylock-Vize P, Naji Y, Tennant R, Fawcett K. Management of iatrogenic urinothorax following ultrasound guided percutaneous nephrostomy. J Radiol Case Rep 2014; 8:34-40. [PMID: 24967012 DOI: 10.3941/jrcr.v8i1.1424] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 64 year-old male with metastatic prostate adenocarcinoma presented with bilateral hydronephrosis and renal impairment. Bilateral percutaneous nephrostomy drainage followed by ante-grade stenting was done. Shortly afterwards, the patient developed an extensive left-sided pleural effusion. His serum creatinine rose and he became anuric. Emergency pleural aspiration and later, pleural drainage were performed. Pleural aspirate was diagnostic of urinothorax and non contrast CT scan demonstrated a left reno-pleural fistula. The right stent was removed cystoscopically. The left stent could not be removed cystoscopically and was replaced in an ante grade manner through a fresh percutaneous renal approach. This led to cessation of pleural fluid accumulation. The patient was discharged with bilateral ureteric stents and normal renal function. A month later, he had normal renal function, no hydronephrosis and normal chest x-rays.
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Affiliation(s)
- Deepak Batura
- Department of Urology, Northwick Park Hospital, London, UK
| | | | - Yaser Naji
- Department of Interventional Radiology, Northwick Park Hospital, London, UK
| | - Rachel Tennant
- Department of Respiratory Medicine, Northwick Park Hospital, London, UK
| | - Katherine Fawcett
- Department of Respiratory Medicine, Northwick Park Hospital, London, UK
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