Urinothorax

Urinothorax is a rare cause of pleural effusion due to the accumulation of urine within the pleural space.

The aetiology of urinothorax can be dichotomised as either due to obstructive uropathy or due to trauma (including iatrogenic post-surgical trauma) to the urinary system 1-3. Urinothoraces are most often seen alongside urinoma, whereby the urine is thought to traverse the diaphragm into the pleural space. Although the pathophysiology of this remains unclear, there are two leading theories: either urine travels through lymphatic drainage into the pleural space, or retroperitoneal urine moves into the peritoneal cavity and then travels directly into the pleural space via a direct transdiaphragmatic passage along a pressure gradient 3.

Markers

The fluid in a urinothorax is usually a transudate but biochemically, often has a low pH and a high LDH and hence may be misclassified as being exudative as per Light's criteria 2-4. However, the most important biochemical feature is the pleural fluid creatinine-to-serum creatinine ratio which is >1, with an average of 1.09–19.80 1-3

Plain radiograph

Chest radiographic appearance of a urinothorax is often indistinguishable form that of another cause of pleural effusion 1. It is reported that urinothorax secondary to obstructive uropathy usually results in bilateral effusions, while those caused by trauma to the urinary tract lead to a unilateral effusion 1, however, there have been numerous case-reports finding the opposite 5.

CT

Again, the appearance of urinothorax on chest CT is indistinguishable from another cause of pleural effusion. However, abdominal CT is useful to detect the cause of the urinothorax 1-3. Many case reports describe later performing renal scintigraphy to confirm a urine leak 1-3.

The exact management strategy will depend on underlying aetiology 1-3. However, the urinothorax should be drained if symptomatic and a urology consult sought 1-3.

Share article

Article Information

rID: 52147
System: Chest
Section: Pathology
Tag: cases
Synonyms or Alternate Spellings:

Support Radiopaedia and see fewer ads

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.