Ann Thorac Surg 2008;85:2141. doi:10.1016/j.athoracsur.2007.08.016
© 2008 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Urinothorax: Urine Discharge From Thorax
Sedat Ziyade, MDb,*,
Murat Ugurlucan, MDa,
Omer Soysal, MDb
a Departments of Cardiovascular Surgery, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
b Bezm-i Alem Vakif Gureba Training and Research Hospital, Thoracic Surgery Clinic, Istanbul, Turkey
* Address correspondence to Dr Ziyade, Yildirim Mahallesi, Ulubatli Sokak, No. 12, Daire: 3, Istanbul, 34390, Turkey (Email: muratugurlucan{at}yahoo.com).
Urine discharge from the thoracic cavity is defined as urinothorax. Pathology usually results from leakage of urine into the pleural cavity through a retroperitoneal route [1].
Our patient was a 52-year-old man with a history of multiple urogenital operations who presented with bilateral hydronephrosis. After bilateral nephrostomy, sudden dyspnea developed in the patient. A chest x-ray film revealed right pleural effusion and he underwent chest tube drainage. The drainage fluid was bright yellow and serous in character. Coincidentally, after the application of the chest tube, urine output from the nephrostomy catheter suddenly ceased. Futhermore, histopathologic and biochemichal evaluation of the pleural drainage fluid indicated that it was urine. Intravenous pyelography was fashioned and a channel diverting the urine from the right kidney to the right hemithorax was detected (Fig 1). He underwent successful bilateral ureterolysis and ileal diversion for the treatment.
Urinothorax is an extremely rare cause for transudative pleural effusion. It is generally iatrogenic and occurs after interventions to treat obstructive uropathy [2]. Precise diagnosis requires identification of a specific channel transfering urine into the thoracic cavity, which is very difficult to identify. However, urinothorax usually resolves spontaneously after the relief of urinary tract obstruction [1].
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References
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- Garcia-Pachon E, Padilla-Navas I. Urinothorax: case report and review of the literature with emphasis on biochemical diagnosis Respiration 2004;71:533-536.[Medline]
- Buyukcelik M, Satar N, Celik U, et al. An unusual cause of pleural effusion, urinothorax in a child with urinary stone disease Pediatr Nephrol 2005;20:1487-1489.[Medline]
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