title: Urinothorax: Case report and systematic review of the literature.
abstract: Urinothorax, the presence of urine in the pleural space, is a rare cause of pleural effusion, usually associated with obstructive uropathy, or urinary trauma. We present the case of a 3 year-old boy and a systematic review of the literature of the 44 cases encountered. After resection of a Wilm's tumour in the right kidney our patient presented acute respiratory distress associated with radiographically confirmed pleural effusion. With the initial diagnosis of pneumonia or malignant pleural effusion, a closed thoracotomy was performed. The liquid obtained suggested urine, which was confirmed by the laboratory. Cystoscopy with retrograde pyelography detected a fistula on the posterior wall of the right kidney. The report of cases worldwide is low, probably due to its low incidence but also to underdiagnosis. Respiratory symptoms are not always present and urological symptoms usually predominate. Diagnosis requires a high degree of clinical suspicion and is confirmed by the main biochemical marker: The ratio >1.0 pleural fluid creatinine and creatinine serum.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Clínica Infantil Colsubsidio, Pontificia Universidad Javeriana, Bogota, Colombia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Casallas
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia.
authors.forename: Camilo
authors.initials: C
authors.lastname: Castañeda-Cardona
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia.
authors.forename: Diego
authors.initials: D
authors.lastname: Rosselli
keywords: Pleural effusion; Wilms tumor; urinothorax; urologic surgical procedures
references.citation: J Assoc Physicians India. 2013 Jul;61(7):490-2
references.pmid: 24772756
references.citation: J Urol. 1986 Apr;135(4):805-8
references.pmid: 3514964
references.citation: Case Rep Emerg Med. 2012;2012:395653
references.pmid: 23326713
references.citation: Arch Intern Med. 1982 Aug;142(8):1509-11
references.pmid: 7103632
references.citation: Clin Chest Med. 2013 Mar;34(1):39-46
references.pmid: 23411055
references.citation: South Med J. 2010 Sep;103(9):931-3
references.pmid: 20689489
references.citation: Respiration. 2004 Sep-Oct;71(5):533-6
references.pmid: 15467335
references.citation: J Trauma. 1978 Aug;18(8):608-10
references.pmid: 682222
references.citation: Pediatr Nephrol. 2005 Apr;20(4):543-6
references.pmid: 15711949
references.citation: Emerg Radiol. 2006 May;12(4):189-91
references.pmid: 16738932
references.citation: Eur Rev Med Pharmacol Sci. 2007 Nov-Dec;11(6):373-4
references.pmid: 18306905
references.citation: AJR Am J Roentgenol. 1981 Jul;137(1):37-41
references.pmid: 6787887
references.citation: Kidney Int. 2009 Aug;76(3):353
references.pmid: 19904260
references.citation: Pediatr Nephrol. 1998 Oct;12 (8):666-7
references.pmid: 9811392
references.citation: Am J Med. 1988 Sep;85(3):448-9
references.pmid: 3414742
references.citation: Obstet Gynecol. 2009 Aug;114(2 Pt 2):482-4
references.pmid: 19622970
references.citation: Scand J Urol. 2013 Jun;47(3):242-3
references.pmid: 22725633
references.citation: Clin Chest Med. 1998 Jun;19(2):407-17
references.pmid: 9646991
references.citation: Pediatr Nephrol. 2005 Oct;20(10 ):1487-9
references.pmid: 16047222
references.citation: Nephrol Dial Transplant. 2007 Jun;22(6):1782-3
references.pmid: 17384414
references.citation: Am J Kidney Dis. 1985 Mar;5(3):211-3
references.pmid: 3883762
references.citation: J Nucl Med. 1986 Jan;27(1):56-9
references.pmid: 3510288
references.citation: J Trauma. 1999 May;46(5):967-9
references.pmid: 10338426
references.citation: Clin Nucl Med. 2008 Dec;33(12 ):889-91
references.pmid: 19033800
references.citation: South Med J. 2007 May;100(5):519-21
references.pmid: 17534092
references.citation: J Radiol Case Rep. 2014 Jan 01;8(1):34-40
references.pmid: 24967012
references.citation: Mayo Clin Proc. 2003 Nov;78(11):1433-4
references.pmid: 14601708
references.citation: Pediatr Nephrol. 2012 Jun;27(6):923-5; 921-2
references.pmid: 21993973
references.citation: Br J Radiol. 1971 Jun;44(522):471-4
references.pmid: 5579179
references.citation: W V Med J. 2011 Nov-Dec;107(6):16-7
references.pmid: 22235706
references.citation: Curr Opin Pulm Med. 2006 Jul;12(4):259-63
references.pmid: 16825877
references.citation: Thorax. 1981 Aug;36(8):632-3
references.pmid: 7314037
references.citation: Respiration. 2002;69(3):273-4
references.pmid: 12097774
references.citation: Urol Ann. 2013 Apr;5(2):61-74
references.pmid: 23798859
references.citation: Singapore Med J. 2007 Nov;48(11):e289-92
references.pmid: 17975679
references.citation: Acta Chir Belg. 2002 Aug;102(4):274-5
references.pmid: 12244910