DOCSLIB.ORG

Unilateral Obstructive Urinothorax Secondary to Colorectal Carcinoma Yuval Tal MD Phd1*, Ido Weinberg MD Msc3*, Arie Ben-Yehuda MD1 and Mordechai Duvdevani MD2

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Unilateral Obstructive Urinothorax Secondary to Colorectal Carcinoma Yuval Tal MD Phd1*, Ido Weinberg MD Msc3*, Arie Ben-Yehuda MD1 and Mordechai Duvdevani MD2 IMAJ • VOL 17 • MAy 2015 CASE COMMUNICATIONS Unilateral Obstructive Urinothorax Secondary to Colorectal Carcinoma Yuval Tal MD PhD1*, Ido Weinberg MD MSc3*, Arie Ben-Yehuda MD1 and Mordechai Duvdevani MD2 1Division of Internal Medicine and 2Department of Urology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel 3Section of Vascular Medicine, Massachusetts General Hospital, Boston, MA, USA metastasis that had been excised 5 and 3 years (PET)-CT was performed and demonstrated KEY WORDS: urinothorax, urinary tract obstruction, earlier, respectively. Consequently he received a para-aortic mass, consistent with tumor colorectal carcinoma, pleural effusion 5-fluorouracil and leucovorin as adjuvant [Figure 1B]. Laparotomy demonstrated that IMAJ 2015; 17: 321–322 therapy for 6 months. Prostate carcinoma, the tumor involved the ligament of Treitz categorized as low risk, had been treated with and the fourth part of the duodenum and radiation and short-term treatment with gos- penetrated the left ureter. Pathologic exami- rinothorax (or urothorax) is the pres- erelin 2 years prior to the current hospitaliza- nation revealed a well-differentiated adeno- U ence of urine in the pleural space. It is tion. His past medical history also included carcinoma staining positively for CDx2 rare, is usually iatrogenic, can occur after pemphigus vulgaris treated with maintenance and carcinoembryonic antigen (CEA) on urinary tract manipulation, or may be due dose prednisone, and ischemic heart disease immunohistochemistry which was noted to to urinary tract obstruction [1]. It can be without congestive heart failure. originate from the colon [Figure 1C, D, E]. bilateral or unilateral, usually on the same On admission he was afebrile and had no Following surgery the patient was side as the obstruction, and resolves after flank pain. Physical examination revealed treated with 2 week cycles of 5-fluorouracil, the obstruction is resolved [2]. Obstructive decreased breath sounds on the left and oxaliplatin, leucovorin and bevacizumab urinothorax in adults is usually secondary dullness to percussion. Cardiac examination on the assumption that he had metastatic to bilateral, and not unilateral obstruction of was normal and there was no jugular venous colon cancer, despite a normal surveillance the urinary tract. When unilateral obstruc- distension or peripheral edema. Chest X-ray colonoscopy. Oxaliplatin was stopped after tion causes urinothorax it is usually associ- revealed left pleural effusion. Pleural tap 8 months of treatment due to neuropathy. ated with an occult nephro-pleural tract or resulted in 1300 ml of clear yellowish fluid, Bevacizumab was discontinued 3 months a single functioning kidney [1]. Only two with lactate dehydrogenase (LDH) of 504 later because of gastrointestinal bleeding. He previous reports described non-traumatic U/L (634 U/L in the serum) and total protein was then treated with 5-fluorouracil, leuco- urinothorax associated with unilateral uri- < 20 g/L. Pleural fluid-to-serum creatinine varin and irinotecan. Repeat colonoscopies nary tract obstruction secondary to tumor. ratio was 117/80 µmol/L. Urea measured and CT did not show recurrence of tumor. In the first, the authors reported a recurrent 14 mg/dl in the fluid and 12.6 mg/dl in the pleural effusion secondary to an abdominal serum. Fluid pH was 6.92. Fluid cytology mass causing hydronephrosis and massive was normal. Computed tomography (CT) of COMMENT urinoma, and in the second, Looi and Lee the chest, abdomen and pelvis demonstrated We present a case of non-traumatic unilateral [2] described urinothorax contralateral to a left pleural fluid accumulation, left hydrone- hydronephrosis associated with urinoma and mildly obstructive renal mass without peri- phrosis and a large perinephric fluid collec- urinothorax. To the best of our knowledge nephric fluid collection. We report a case of tion [Figure 1A]. Urine cytology revealed this is the first such case secondary to metas- non-traumatic urinothorax associated with cancerous cells. Fluid re-accumulated tasis of colon adenocarcinoma penetrating unilateral urinary tract obstruction and despite repeated pleural taps. A thoracocen- the ureter. Suggested mechanisms for uri- perinephric fluid accumulation. tesis was performed and 4 L of fluid were nothorax include extension of urine through evacuated. Repeat pleural fluid cytological the diaphragm or its passage via lymphatic examinations failed to demonstrate cancer- connections between the peritoneum and PATIENT DESCRIPTION ous cells. Hydrothorax was eliminated only pleural space following the negative intra- A 71 year old man presented after a week of after insertion of a nephrostomy drain and pleural pressure [2]. The presence of urinoma fever (38°C), chills and shortness of breath. did not recur. Ureteroscopy was performed, in our case suggests the first mechanism. His medical history consisted of stage II showing external pressure on the left ureter, Urinothorax has been previously describ- sigmoid adenocarcinoma and a single liver without any sign of urothelial tumor. The ed in relation to bilateral urinary tract obstruc- *The first two authors contributed equally to rest of the examination was within nor- tion, urinary tract manipulations, inflam- this study mal limits. Positron emission tomography mation, malignancy, trauma, shock wave 321 CASE COMMUNICATIONS IMAJ • VOL 17 • MAy 2015 case. The urea concentration in the pleural A B fluid was similar to that of the serum. Urea has a low molecular weight and diffuses rapidly through the pleura [4]. Of note, in most previous reports no biochemical characteristics of the fluid were provided and the diagnosis was made according to the clinical relationship with urinary tract obstruction, also present in our case [1]. Spontaneous urinothorax is a rare clini- cal manifestation and seldom anticipated; diagnosis and treatment can be mislead- [A] Axial CT image of the patient’s chest showing a large left [B] Axial CT image of the patient’s abdomen, showing ing. A therapeutic trial with furosemide pleural effusion displacing the mediastinum to the right a retroperitoneal mass (arrow) and fluid collection can actually elevate pleural fluid quantity around the left kidney (arrowheads) by increasing urine output, thus produc- ing more fluid. As in the case presented, C treatment of the urinary tract obstruction resolves the urinothorax. Recently a large retrospective trial was published in support of non-operative management of urinomas; however, the research referred only to blunt trauma-related renal injuries and conclu- sions could not be drawn for the manage- ment of non-traumatic obstructions [5]. In conclusion, non-traumatic, unilateral [C] Axial PET image of the patient’s abdomen showing radionucleotide uptake correlating to the retroperitoneal mass urinothorax is a rare clinical manifestation of upper urinary tract obstruction. Elimination D E F of the obstruction can alleviate or even elimi- nate the process. We therefore suggest that in the presence of unilateral hydrothorax urino- thorax be suspected and sought, especially in patients with a history of metastatic cancer. Correspondence Dr. Y. Tal [D] Well-differentiated adenocarcinoma, composed of well-defined malignant glands (hematoxylin & eosin, Allergy and Clinical Immunology Unit, Dept. of original magnification x 200). The neoplastic epithelial cells are immunoreactive for the colonic markers CDx2 Medicine, Hadassah-Hebrew University Medical Center (Ein Kerem Campus), P.O. Box 12000, [E] and CEA [F] (original magnification x 400) Jerusalem 91120, Israel email: [email protected] lithotripsy, and posterior urethral valve. also failed to find additional non-traumatic References Congenital cases also exist. It has been unilateral causes for urinothorax. Obstruc- 1. Garcia-Pachon E, Romero S. Urinothorax: a new suggested that urinothorax can be either tive urinothorax was considered different approach. Curr Opin Pulm Med 2006; 12: 259-63. 2. Looi LM, Lee P. An unusual case of unilateral obstructive, following bilateral urinary to traumatic and was defined as bilateral. transudative pleural effusion. Chest 2006; 130: 328S. tract obstruction, or traumatic, which is Accordingly, only two cases of unilateral non- 3. Tsai CF, Liao CY, Lin CH, Shiao CC. Huge urinoma usually unilateral [1]. Unilateral ligation of traumatic urinary tract obstruction associ- presenting as a bulging mass. Nephrology 2013; 18: the ureter in dogs failed to produce urino- ated with urinothorax were previously de- 477. 4. Laskaridis L, Kampantais S, Toutziaris C, et al. thorax. A recently published case described scribed. Urinothorax – an underdiagnosed cause of acute a unilateral urinoma secondary to obstruc- Urinothorax is the only cause of a tran- dyspnea: report of a bilateral and of an ipsilateral urinothorax case. Case Rep Emerg Med 2012; 2012: tion from nephrolithiasis in a patient with sudate with low pH (pH < 7.3), although 395653. multiple metastases. Although the obstruc- the LDH in the fluid may be relatively high 5. van der Wilden GM, Velmahos GC, Joseph DK, tion resulted in a large abdominal bulging [1]. A pleural fluid-to-serum creatinine et al. Successful nonoperative management of the most severe blunt renal injuries: a multicenter mass, it did not evolve to urinothorax [3]. ratio greater than 1 may be sensitive, albeit study of the research consortium of New England Comprehensive review of the literature not specific [1]. This is consistent with our Centers for Trauma. JAMA Surg 2013; 148: 924-31. 322 .
Load more

Recommended publications
  • Urinothorax After Ultrasonography-Guided Renal Biopsy
    Lee et al. BMC Nephrology (2018) 19:104 https://doi.org/10.1186/s12882-018-0903-8 CASE REPORT Open Access Urinothorax after ultrasonography-guided renal biopsy: a case report Tae Won Lee1, Ha Nee Jang2, Hyun Seop Cho2, See Min Choi3,5, Bong-Hoi Choi4,5, Eunjin Bae1, Se-Ho Chang2,5,6 and Dong Jun Park1,5,6* 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. Keywords: Urinothorax, Pleural effusion, Renal biopsy Background clinical conditions, such as urologic complications, can Urinothorax refers to the presence of urine in the make it difficult to diagnose early, resulting in severe pleural space, but rarely causes pleural effusion [1]. Since clinical situations, such as a large volume drainage after the first description in 1968 by Corriere et al., fewer than inserting a chest tube and respiratory failure.
    [Show full text]
  • Viewed and Edited the Trauma, Kidney Biopsy, Kidney Transplantation, Manuscript
    Clinical Images in Nephrology and Dialysis Acute Dyspnea in a Young Woman Following Percutaneous Nephrostomy Tube Placement Ei Khin , Ittay Moreno, and Indu Pathak KIDNEY360 2: 773–775, 2021. doi: https://doi.org/10.34067/KID.0006042020 Case Description extracorporeal shortwave lithotripsy, or bladder lacer- A previously healthy 16-year-old woman was admit- ation (3,4). It is a reversible condition once the un- ted to hospital for fever and dysuria for 1 day, and derlying disease process is resolved. However, at worsening of intermittent pain in the left costovertebral times, interventions may be required, including thora- area and left lower quadrant of abdomen for the last cotomy and pleural decortication (5). 3 days. Management consists of treating the underlying The patient denied urinary frequency, urgency, nau- uropathy and draining the pleural fluid via thoraco- sea, or vomiting. There was no history or family history centesis. The urinothorax resolved completely in our of kidney stones. patient after chest tube drainage and the misplaced On physical examination, the patient was noted to be nephrostomy tube was replaced with a new one, ap- an overweight adolescent with Tmax 102.9 F and mild propriately positioned in the collecting system. left costovertebral angle tenderness noted on abdomen examination. Laboratory results showed a white blood cell count Teaching Points of 12,700 cells/ml, erythrocyte sedimentation rate of 67 mm/hr, C-reactive protein level .18 mg/dl, and c A urinothorax should be suspected when patients serum creatinine of 1 mg/dl. develop dyspnea, chest pain, and unilateral pleural Urinalysis demonstrated moderate ketones and leu- effusion after having kidney or ureteral surgical pro- kocyte esterase, negative nitrites, numerous white cedures or with obstructive uropathy.
    [Show full text]
  • Urinothorax: an Unusual Cause of Pleural Effusion Handa A, Agarwal R, Aggarwal a N
    Case Report Singapore Med J 2007; 48(11) : e289 Urinothorax: an unusual cause of pleural effusion Handa A, Agarwal R, Aggarwal A N ABSTRACT examination, the patient was febrile (38.3°C) with Urinothorax refers to the presence of a pulse rate of 112 beats/minute, blood pressure of urine in the pleural space secondary to 110/72 mmHg, and a respiratory rate of 33 breaths/ obstructive uropathy, and is an unusual minute. There was pallor, but no jaundice, pedal cause of pleural effusion. The importance oedema, lymphadenopathy, icterus or clubbing. of recognising this entity lies in the fact Examination of the respiratory system showed that the condition is completely reversible decreased movements, dull percussion note and following relief of urinary tract obstruction. absent breath sounds in the entire right hemithorax, We describe a 35-year-old man who consistent with massive pleural effusion. There were developed urinothorax following a no adventitious sounds. Examination of the other percutaneous nephrolithotomy for renal systems, including the abdomen, cardiovascular system calculi. We also reviewed the literature and nervous system, was normal. for reported cases between 1968 and 2006. Chest radiograph showed massive pleural effusion on the right side, and serial radiographs showed development Keywords: hydrothorax, obstructive of a loculated effusion. The biochemical profile, uropathy, pleural effusion, urinothorax including serum electrolytes, renal and liver function, Singapore Med J 2007; 48(11):e289–e292 was normal. Complete blood count revealed haemoglobin of 8.5 g/dL, total leucocyte count INTRODUCTION 36,800/μL with predominant neutrophils, and a platelet Urinothorax refers to the presence of urine in the count of 4.9 × 105/μL.
    [Show full text]
  • Pleural-Effusions.Pdf
    Short Communication iMedPub Journals 2018 http://www.imedpub.com/ www.imedpub.com Insights in Chest Diseases Vol. 3 No. 1:1 Pleural Effusions Funda Ozturk Incekara*, Deniz Kaygusuz Tikici and Hakan Nomenoglu Received: January 15, 2018; Accepted: January 22, 2018; Published: February 05, 2018 Department of Thoracic Surgery, Ataturk Chest Diseases and Thoracic Surgery Introduction Trained and Research Hospital, Ankara, Pleural effusion is defined as a fluid collection between the Turkey pleural leaves due to local/systemic disease of the pleura, lung or extrapulmonary organs. Normally, 0.1 to 0.2 ml/kg of fluid is present in the pleural leaves to facilitate pleural movement. When the balance between the production and reabsorption of *Corresponding author: this fluid deteriorates, it becomes pleural effusion [1]. Funda Ozturk Incekara Mechanisms of pleural effusion can be summarized as [1,2]. • Increased hydrostatic pressure in the microvascular [email protected] circulation Department of Thoracic Surgery, Ataturk • Decreased oncotic pressure in the microvascular circulation Chest Diseases and Thoracic Surgery • Increased negative pressure in the pleural space Trained and Research Hospital, Ankara, Turkey. • Separation of pleural leaves • Increased permeability in the microvascular circulation Tel: 00905057682387 • Decrease in lymphatic drainage capacity • Transition from the abdomen to the thorax Citation: Incekara FO, Tikici DK, The prevalence of pleural effusion is estimated at 320/100000 and Nomenoglu H (2018) Pleural Effusions. is seen as equal in both genders. However, malignant effusions Insights Chest Dis Vol.3 No.1:1 are more common in women due to breast and gynecological cancers, while malignant mesothelioma and pancreatitis- associated effusions are more frequent in males [3].
    [Show full text]
  • Massive Urinothorax; a Rare Complication After Percutaneous Nephrolithotomy
    Bozkurt et al. Clin Med Rev Case Rep 2015, 2:12 ISSN: 2378-3656 Clinical Medical Reviews and Case Reports Case Report: Open Access Massive Urinothorax; A Rare Complication after Percutaneous Nephrolithotomy Ibrahim Halil Bozkurt, Salih Polat*, Ismail Gulden, Serkan Yarımoglu, Ozgu Aydogdu, Tar- ik Yonguc and Volkan Sen Bozyaka Training and Research Hospital, Izmir, Turkey *Corresponding author: Salih Polat, MD, Bozyaka Training and Research Hospital, Izmir, Turkey, Tel: +90 54 322 93 29, Fax: +90 232 26 44 44, E-mail: [email protected] of complication during the PCNL. Oxygen saturation and peak Abstract airway pressure were within normal limits during operation. There The urinothorax or collection of urine in the pleural space is a rare was no residual fragments in fluoroscopy images at the end of the complication following percutaneous nephrolithotomy (PCNL). We procedure. Extravasation and/or pleural leakage was not seen in present a case of massive urinothorax who had undergone PCNL. pyelogram that was obtained after nephrostomy placement. We Two weeks after PCNL, the patient was admitted to the emergency perform routine chest X-ray imaging at preoperative [Figure 1a] and clinic with dyspnea, chest pain and fever. Thorax and abdomen computed tomography (CT) revealed massive pleural effusion on postoperative day 1 (POD 1) in patients who had undergone PCNL the left hemithorax and a stone located at the proximal segment using intercostal access. The control chest X-ray of this patient at of left ureter. A chest tube and a ureteral DJ stent was placed POD 1 was normal [Figure 1b]. The nephrostomy tube was removed for drainage.
    [Show full text]
  • Short Reports Pleural Effusion Associated with Urinary Tract Obstruction: Support for a Hypothesis
    Thorax: first published as 10.1136/thx.36.8.632 on 1 August 1981. Downloaded from Thorax 1981 ;36:632-633 Short reports Pleural effusion associated with urinary tract obstruction: support for a hypothesis FW LEUNG, AJ WILLIAMS, PA OILL From the Medical and Research Services, VA Wadsworth Medical Center, Los Angeles, California, USA Pleural effusions associated with urinary tract obstruction cases (urinothorax) appear to be unusual, only eight '. , having been reported since the first description by Corriere and his colleagues in 1968.1 The patient described here developed a pleural effusion associated with spontaneous perinephric extravasation of urine secondary to ureteral obstruction. However, the differing chemical composition of these fluids indicates that direct extension of urine into the pleural space, as previously suggested, had not occurred, and we propose that pleural effusions associated with urinary tract obstruction develop by another mechanism. Case report A 65-year-old black man was admitted to the Veterans Administration Wadsworth Medical Center complaining of weight loss and abdominal pain, associated with copyright. malaise, anorexia, constipation, and frequent post- prandial vomiting. One week before admission a chest radiograph and barium studies were reported as normal. The past history included a prostatic carcinoma treated with radiation therapy in 1976 and a benign cyst of the left kidney demonstrated by intravenous pyelography in Fig I Chest radiograph showing left pleural effusion. http://thorax.bmj.com/ 1978. There was no history of cardiovascular disease. On admission, abnormal physical signs included decreased moderately well-differentiated adenocarcinoma. A retro- breath sounds and dullness to percussion posteriorly over grade pyelogram showed complete obstruction of the the left chest.
    [Show full text]
  • Management of Iatrogenic Urinothorax Following Ultrasound Guided Percutaneous Nephrostomy Batura Et Al
    Genitourinary Management of iatrogenic urinothorax following ultrasound guided percutaneous nephrostomy Batura et al. Radiology: Management of iatrogenic urinothorax following ultrasound guided percutaneous nephrostomy Deepak Batura1*, Patricia Haylock-Vize1, Yaser Naji2, Rachel Tennant3, Katherine Fawcett3 1. Department of Urology, Northwick Park Hospital, London, UK 2. Department of Interventional Radiology, Northwick Park Hospital, London, UK 3. Department of Respiratory Medicine, Northwick Park Hospital, London, UK * Correspondence: Deepak Batura, Ealing Hospital NHS Trust, Uxbridge Road, Southall, UB1 3HW, United Kingdom ( Deepak Batura:[email protected]) Radiology Case. 2014 Jan; 8(1):34-40 :: DOI: 10.3941/jrcr.v8i1.1424 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 www.RadiologyCases.com 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. CASE REPORT pleural effusion (Fig. 4). Initially he had a urine output of 835 JournalRadiology of Case Reports CASE REPORT ml from his right-sided nephrostomy and no urine output A 64 year-old Caucasian male with previously diagnosed urethrally.
    [Show full text]
  • Nefroefro - 29-429-4 - Ccasease 3 - Uurinothorax.Inddrinothorax.Indd 1 007/12/20157/12/2015 115:14:205:14:20 CMYKP
    CASE REPORT Port J Nephrol Hypert 2015; 29(4): 000-000 Advance Access publication 7 December 2015 Urinothorax – an uncommon complication following renal transplantation: a case report Urinotórax – uma complicação rara após o transplante renal: caso clínico Joel Ferreira, Rita Gouveia, Ana Mateus, Pedro Cruz, Carlos Oliveira, José M. Carvalho, Maria J. Ferreira, Aura Ramos Department of Nephrology, Renal Transplantation Unit, Hospital Garcia de Orta, Almada, Portugal. Received for publication: 20/08/2015 Accepted in revised form: 21/10/2015 ABSTRACT Urinothorax is an uncommon cause of pleural effusion, mostly related to urinary tract injury or obstruc- tive uropathy. Several pathophysiological mechanisms have been proposed to explain the transdiaphragmatic evasion of urine from an intra-abdominal collection known as urinoma. Biochemical analysis of pleural fluid and imagiological studies are essential for diagnosis, which requires a high index of suspicion. Treatment directed to the underlying cause and aimed at reducing intra-urinary pressure is sufficient in most cases. We report herein the case of a urinothorax in a young kidney transplant recipient. An early urinary leak occurred through an infarction area of the kidney graft. Successful conservative treatment involved thora- cocentesis and prolonged double-J stenting and Foley catheterization. Key-Words: Kidney transplantation; pleural effusion; urinoma. RESUMO O urinotórax constitui uma causa rara de derrame pleural, associando-se geralmente a lesões do trato urinário ou à uropatia obstrutiva. Vários mecanismos fisiopatológicos foram propostos para explicar o extrava- samento transdiafragmático de urina a partir de uma colecção intra-abdominal conhecida como urinoma. A análise bioquímica do líquido pleural e meios complementares de imagem são fundamentais para o diagnóstico que requer um elevado grau de suspeição.
    [Show full text]
  • Bilateral Urinothorax Following Spontanious Extravasation from the Kidney-Speculation of an Anatomical Pathway for the Transport
    QATAR MEDICAL JOURNAL | VOL. 17 / NO. 2 / DECEMBER 2008 CASE REPORT Bilateral Urinothorax Following Spontanious Extravasation from the Kidney-Speculation of an Anatomical Pathway for the Transport of Extravasated Urine to the Pleural Cavities: A case report and review of the literature *Muzhrachi A.,**Prasad K.V. * Radiology Department and ** Urology Section, Surgery Department Hamad Medical Corporation, Doha, Qatar Abstract: the patient underwent further investigations. A pre-contrast The pathway of extravasated urine from the retroperi- CT scan of the abdomen, five days after admission, showed toenum to the ipsilateral and contralateral pleural cavity in retroperitoneal collection of fluid in the posterior pararenal cases of urinothorax has been of debate in the literature. area, starting at the hilum of the right kidney and extending We present a proposed route for the extravasated urine upwards above the upper pole of right kidney, well separated pathway from the retroperitoenum to both pleural cavities from the posterior surface of the kidney by perirenal fat and based on radiological evidence. in close contact with postero-medial part of the right dome of diaphragm (Figure 1). A thick sheet like structure of fluid Introduction: density was demonstrated on either side of para-spinal space, Collection of urine in the thoracic cavity has been reported which was thicker on the right side, starting from the level of following urinary tract obstruction^1"4). The majority of thoracic the urinoma and extending upwards along the inner surface urine collections have been confined to the same side as that of of the crura of the diaphragm into the posterior mediastinal urinary tract obstruction(5).
    [Show full text]
  • Urinothorax: an Unexpected Cause of Pleural Effusion in a Patient with Non-Hodgkin Lymphoma
    European Review for Medical and Pharmacological Sciences 2007; 11: 373-374 Urinothorax: an unexpected cause of pleural effusion in a patient with non-Hodgkin lymphoma K. KARKOULIAS, F. SAMPSONAS, A. KAPARIANOS, M. TSIAMITA, G. TSOUKALAS*, K. SPIROPOULOS University of Patras, University Hospital of Patras, Department of Internal Medicine, Division of Pneumology, Rio, Patras (Greece) *Chest Hospital Sotiria, Athens (Greece) Abstract. – Urinothorax is a rather rare Case Report cause of pleural effusion and its potential mechanism is urinary tract obstruction or trau- A 47 year old man was admitted to the Emer- ma that results in urine leakage and accumula- gency Department because of dyspnea and non- tion inside the pleural space. Patients with non- productive cough. He had a history of non- Hodgkin lymphoma could present with pleural Hodgkin lymphoma diagnosed 4 years ago. He effusion due to mediastinal lymphadenopathy underwent two chemotherapy schemata in 2002 or extrathoracic manifestation such as urinary tract obstruction, the latter described in our and 2003 with an additional radiotherapy in the case report. Physicians must be aware even of same period and subsequently underwent autolo- the more occult mechanisms of pleural fluid ac- gous bone marrow tissue transplantation. Follow- cumulations which could point to extrathoracic ing these therapeutical interventions the patient manifestations of involvement. was asymptomatic. On presentation, during physical examination Key Words: he was alert, and oriented but tachypneic with a Pleural effusion, Non-Hodgkin lymphoma, respiratory rate of 25 per minute. Blood pressure Urinothorax was 130/80 mmHg, pulse 100bpm and tempera- ture 37 oC. Oxygen saturation was 92% to the room air.
    [Show full text]
  • Urinothorax Caused by Xanthogranulomatous Pyelonephritis Waiel Abusnina
    Marshall University Marshall Digital Scholar Internal Medicine Faculty Research 6-14-2018 Urinothorax Caused by Xanthogranulomatous Pyelonephritis Waiel Abusnina Hazim Bukamur Zeynep C. Koc Follow this and additional works at: https://mds.marshall.edu/int_med Part of the Internal Medicine Commons, Nephrology Commons, and the Urology Commons Hindawi Case Reports in Pulmonology Volume 2018, Article ID 7976839, 3 pages https://doi.org/10.1155/2018/7976839 Case Report Urinothorax Caused by Xanthogranulomatous Pyelonephritis Waiel Abusnina ,1 Hazim Bukamur,2 Zeynep Koc,3 Fauzi Najar,3 Nancy Munn,2,4 andFuadZeid 2 1 Department of Internal Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia 25701, USA 2Department of Pulmonary Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia 25701, USA 3Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia 25701, USA 4VeteransAfairsMedicalCenter,Huntington,WestVirginia25704,USA Correspondence should be addressed to Waiel Abusnina; [email protected] Received 9 April 2018; Accepted 28 May 2018; Published 14 June 2018 Academic Editor: Inger F. Oey Copyright © 2018 Waiel Abusnina et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis that generally aficts middle-aged women with a history of recurrent urinary tract infections. Its pathogenesis generally involves calculus obstructive uropathy and its histopathology is characterized by replacement of the renal parenchyma with lipid flled macrophages. Tis ofen manifests as an enlarged, nonfunctioning kidney that may be complicated by abscess or fstula.
    [Show full text]
  • A Rare Cause of Pleural Effusion Rahul Gupta, Pritpal Singh*
    JK SCIENCE CASE REPORT Urinothorax - A Rare Cause of Pleural Effusion Rahul Gupta, Pritpal Singh* Abstract Urinothorax is a rare cause of pleural effusion, which is mostly seen secondary to obstructive uropathy. We report a patient who had nephrolithasis and underwent percutaneous nephrostomy for treatment of hydroureteronephrosis. The patient developed right-sided pleural effusion, five days after percutaneous nephrostomy, which was later diagnosed as urinothorax. Although rare, urinothorax should be considered in the differential diagnosis of causes of pleural effusion, especially in patients with obstructive uropathy, any form of instrumentation of urinary tract or blunt abdominal trauma.The importance of recognizing this entity lies in the fact that the condition is completely reversible following relief of urinary tract obstruction. Key Words Hydroureteronephrosis (HUN), Thoracacentesis, Percutaneous Nephrostomy (PCN), Pleural Effusion, Urinothorax Introduction Case Report Urinothorax refers to the presence of urine in the A 75 year old female with fever and progressive pleural space, is a rare cause of pleural effusion secondary increase in breathlessness and a history of decreased to obstructive uropathy. Corriere et al first described urine output was admitted in hospital .The patient had urinothorax in 1968 when they studied urethral undergone PCN at another institution for treatment of obstructions in dogs. (1) Since then only few cases of renal calculus induced HUN in the right kidney five days urinothorax in humans have been reported in the literature. back. There was no history of cough, expectoration, chest (2) The urine moves into the pleural space from the pain, dysuria, pyuria, haematuria or abdominal pain. She retroperitoneal space via the diaphragmatic lymphatics had a past history of hypertension and was on calcium or through an anatomical defect in the diaphragm.
    [Show full text]