Urinothorax: Report of 4 Cases and Review of the Literature

Abstract

Urinothorax should be considered when pleural effusion occurs in patients with urinary tract obstruction accompanied by retroperitoneal urinoma. This recommendation is based on our experience with 4 cases and a review of the literature. In 2 patients urinary obstruction was owing to retroperitoneal fibrosis secondary to malignancy, including one who had a neuroectodermal undifferentiated small round cell tumor and the other who had a metastatic epithelial neoplasm. In the 2 other patients urinary obstruction resulted from a failed ureteroneocystotomy following renal allograft transplantation. All 4 patients had a urinoma, which may be a predisposing factor to urinothorax.

Urinothorax: Case Report and Review of the Literature with Emphasis on Biochemical Diagnosis

“…The pleural fluid is a transudate that looks and smells like urine. Most cases are diagnosed retrospectively, that is, when pleural effusion resolves following urinary diversion [3]. …”

Urinothorax: a systematic review

“…The pH in UT is usually acidic (60% had pH ≤7.30) which is explained by the presence of clearly acidotic urine. However, in 24% (6/25) of the cases reviewed, pH level was ≥7.50 (21,48,56,66,78). It has been speculated that urinoma with hematuric urine, in addition to raising PF protein levels, could have the same effect on the pH (50), but in this review none of the 6 cases with pH ≥7.50 had hematic PF.…”

“…Figure 1 presents a flowchart showing a complete breakdown (2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) of how (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) appropriate studies (45)(46)(47)(48)(49)(50)(51)(52)(53)(54)…”

“…The mechanism of urine transit has been much debated. One theory is that it ascends directly through anatomical defects of the diaphragm, but it seems more likely that the collection of urine migrates into the pleural space through diaphragmatic lymphatics due to increased retroperitoneal or intraperitoneal pressure caused by urinoma (21). In cases of traumatic origin, the disruption of urinary excretion pathways was associated with unilateral PE.…”

“…and was either lymphocyte-predominant (>50%, 4/9, 44.4%) (27,30,59,65) or polymorphonuclear (5/13; 38.5%) (21,39,47,61,70). In 3 patients, PF culture was positive: two presented Proteus (5,15) while the microorganism was not mentioned in the third, but the treatment was based on PF culture findings (61).…”