An 83-year-old male underwent microwave ablation for a renal mass and in return develops urine leakage in the chest cavity or in other words: Urinothorax!
Urinothorax is a quite rare diagnosis characterised by presence of urine in the pleural space. The urine may leak secondary to renal or ureteric surgical complications, trauma, retroperitoneal inflammation, obstructive uropathy, and malignant diseases. A technetium 99 m renal scan or excretory phase computed tomography scan can confirm the diagnosis.
Case:
An 83-year-old presented with complaints of a progressively growing mass on the right side of the abdomen. The doctors had biopsied the mass and diagnosed it to an oncocytoma.
However, over the course of 8 months, the mass grew from 2.8 cm to 3.6 cm. Consequently, the doctors suspected a sampling error. Moreover, a multidisciplinary team decided to ablate the mass percutaneously.
Therefore, the patient underwent microwave ablation (MWA) of the 2.9 × 3.6 cm with 3 probes at 90W for 10 minutes (Long Perseon Microthermx®). The expected zone of ablation zone was 4 × 5.3 cm.
However, after 3 months, the patient complained of shortness of breath. The doctors diagnosed him with pleural effusion. They performed multiple thoracenteses, but his symptoms couldn’t be relieved. Therefore, the patient underwent placement of a tunnelled pleural catheter to resolve the high-volume, refractory effusions.
Since urinothorax was suspected during tube placement, the doctors sent a sample of the collected fluid for fluid creatinine, which was 52 mg/dl (concurrent serum creatinine was 0.8 mg/dl).
An excretory phase computed tomography scan revealed an accumulation of contrast in the chest. Therefore, the CT scan confirmed the diagnosis of urinothorax.
His doctors then placed a percutaneous nephroureteral (PCNU) tube for urinary diversion and output from the chest tube abated.
After a month, the patient underwent removal of PCNU tube. However, after the tube removal, subsequently urinothorax recurred.
Ultimately, the patient opted for right nephrectomy rather than additional stenting.
Despite the rarity of the disease, any patient who presents with respiratory symptoms suggesting a diagnosis of pleural effusion after a recent genitourinary intervention should be evaluated for urinothorax.
Reference:
Miller M, Hamilton B, Quencer K (2020) Urinothorax Following Microwave Ablation of a Renal Mass. Int Arch Urol Complic 6:075. doi.org/10.23937/2469-5742/1510075
