Abstract
The first case of urinothorax in Japan was reported.
A 67 year old man was admitted to our hospital because of hemoptysis and was diagnosed as having metastatic lung cancer from pancreas cancer.
Fifty days after admission, he complained of flank tenderness and lateral chest wall swelling in only the left side. The fluid collection in the left pleural cavity was found on chest X-ray film and BUN and serum creatinine level also were elevated at this time. Thoracentesis yielded a large amount of yellow fluid with a creatinine concenration of 10.1mg/dl, urea nitrogen of 123mg/dl and total protein 0.3g/dl with concomitant serum level 9.2mg/dl, 115mg/dl and 6.8g/dl, respectively. The central venous pressure did not elevate. Although some questions remained, we diagnosed acute renal failure with pleural effusion at this stage.
Abdominal CT scan showed urinoma in the left retroperitoneal space and multiple renal cysts of bilateral kidneys. A left percutaneous nephrostomy catheter was put in place. A nephrostogram performed through the catheter demonstrated extravasation of contrast material from the renal pelvis and confirmed the abdominal urinoma.
After drainage, the serum creatinine and BUN levels immediately fell and left pleural effusion diminished. At the same time, swelling of left lateral chest wall and left flank pain disappeared.
Thirty days after drainage, he suddenly died because of aspiration. Pancreas cancer, lymphangitis carcinomatosa, multiple renal cysts were revealed and left ureteral obstruction caused by cancer invasion were proved at autopsy.
We therefore conclude that his pleural fluid was urinothorax secondary to the urinoma.
When pleural fluid shows higher level of creatinine than that of serum, we should consider the possibility of urinothorax.
