Urinothorax: A rare cause of severe respiratory distress

Abstract

A case of massive right pleural effusion in a postoperative patient of percutaneous nephrolithotomy leading to severe respiratory distress is reported. A high degree of clinical suspicion and prompt intervention by insertion of an intercostal drainage tube prevented the patient from going in to respiratory failure. The development of arrhythmias confused the picture increasing the morbidity of the patient. However, the patient was managed in an intensive care unit with intercostal chest tube insertion and antiarrhythmic agents. After correction of the specific cause of the effusion the intercostal tube was removed on the 4th day without further recurrence of the effusion.

Urinothorax in a child secondary to obstructive renal stone in a solitary functioning kidney: a case report

“…Further cases were reported in humans as well. It is classified as either obstructive or traumatic urinothorax [3]. Effusion is mostly unilateral and corresponding to the obstructed kidney.…”

“…It is bilateral if there is bilateral obstructive uropathy [4]. It is due to the leakage of urine into retroperitoneal space that migrates to the pleural cavity via diaphragmatic lymphatic or through defects in diaphragm [1,3,6]. Patients usually present with dyspnea, flank pain, and fever [2,6].…”

“…The pleural fluid is transudate in nature, fulfilling the Light's criteria with the exception of a raised LDH [1]. The fluid usually has low glucose, low protein, and low pH in most cases [1][2][3]. A delay in fluid analysis may decrease the sensitivity as the equilibrium between serum and fluid [8].…”

“…A delay in fluid analysis may decrease the sensitivity as the equilibrium between serum and fluid [8]. A pleural fluid to creatinine ratio of more than 1 helps to differentiate urine from bodily fluids [1,3,5]. The mainstay management is to unblock the obstructive urinary system and drain the pleural fluid with thoracentesis' [5,6].…”

“…The serum creatinine came down to 1.69 g/dL on the first post-operative day and 0.54 g/dL on the second post-operative day. Pleural fluid for creatinine was 8.26 g/ dL, pH 8.0, total leukocyte count (TLC) 271 per mm 3 with polymorph 60 %, protein \0.8 gm/dL, glucose 121 mg/dL, and lactate dehydrogenase (LDH) 86 Units/L. Gram staining, acid fast bacilli (AFB) staining, and Mycobacterium tuberculosis (MTB) DNA by polymerase chain reaction (PCR) of the pleural fluid were negative.…”