Urinothorax—An Underdiagnosed Cause of Acute Dyspnea: Report of a Bilateral and of an Ipsilateral Urinothorax Case

Abstract

Urinothorax (UT) is a rare and often undiagnosed condition, defined as the presence of urine in the pleural cavity due to the retroperitoneal leakage of urine accumulation, known as urinoma, into the pleural space. UT usually is a transudative pleural effusion that presents in patients with obstructive uropathy and it may occur following surgical procedures in the ureter or kidney such as ESWL, PCNL, and URS. Its diagnosis requires a high degree of clinical suspicion since the respiratory symptoms tend to be absent or mild and the urological signs tend to dominate. However, UT may rarely present with severe and acute dyspnea as well. The objectives of this study are to describe two new cases of this rare entity, a bilateral case and an ipsilateral case focusing on the side that occurs according to the affected renal insult, and to alert the physicians to include UT in their differential diagnosis of pleural effusions especially in patients with recent urinary tract disorders.

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

“…It was first described in 1968 by Corriere et al in dogs with ureteral obstruction [2]. Further cases were reported in humans as well.…”

“…Urinothorax is collection of urine in the pleural cavity and is a very rare presentation of pleural effusion [1,2]. It was first described in 1968 by Corriere et al in dogs with ureteral obstruction [2].…”

“…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]. Chest X-rays show extensive pleural effusion without any demonstrable etiology [2,7].…”

“…Patients usually present with dyspnea, flank pain, and fever [2,6]. Chest X-rays show extensive pleural effusion without any demonstrable etiology [2,7]. CT scan and nuclear scans may show the presence of a reno-pleural fistula [5].…”

“…It is a rare and very unusual presentation of pleural effusion mostly secondary to trauma or obstructive uropathy [1,2]. Obstructive uropathy leading to urinothorax may be due to prostatic hypertrophy, renal cysts, posterior urethral valve, prostatic carcinoma, renal calculi, and renal transplantation [1,8].…”