The Urinothorax: A Comprehensive Review With Case Series

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 an...

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Published inThe American journal of the medical sciences Vol. 354; no. 1; p. 44
Main Authors Austin, Adam, Jogani, Sidharth Navin, Brasher, Paul Bradley, Argula, Rahul Gupta, Huggins, John Terrill, Chopra, Amit
Format Journal Article
LanguageEnglish
Published United States 01.07.2017
Subjects
Aged
Aged, 80 and over
Exudates and Transudates - diagnostic imaging
Female
Humans
Hydronephrosis - complications
Hydronephrosis - surgery
Kidney - diagnostic imaging
Male
Middle Aged
New York
Pleural Effusion - complications
Pleural Effusion - surgery
South Carolina
Urinoma - diagnosis
Urinoma - etiology
Urinoma - surgery
Pleural effusion
Urinothorax
Urinoma
Obstructive uropathy
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Summary: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.
ISSN:1538-2990
DOI:10.1016/j.amjms.2017.03.034