The patient is a 16-year-old primigravid woman with past medical history of recurrent childhood UTIs and prior treatment for right pyelonephritis with hydronephrosis at 28 weeks’ gestation. At that time she had a right percutaneous nephrostomy tube placed with subsequent resolution of the right hydronephrosis. Her urine culture grew Stenotrophomonas maltophilia and she completed therapy with trimethoprim-sulfamethoxazole. At 34 weeks’ gestation, she presented to the hospital with fevers and left flank pain. She was found to have a left calyceal staghorn calculus with left hydronephrosis. She subsequently had a left percutaneous nephrostomy tube placed. The following day, she developed severe left flank pain, tachycardia, and subjective dyspnea. CT of the chest, abdomen, and pelvis showed a large left-sided pleural effusion with near-total collapse of the left lung, bilateral hydronephrosis, and a 2 millimeter stone present within the urinary bladder. She received thoracentesis with drainage of 800 cc of amber-colored fluid, and her signs and symptoms resolved. Fluid studies returned pleural fluid:serum creatinine ratio of 2.8, which suggested urinothorax as the etiology of her effusion. Antegrade nephrostogram was performed prior to discharge and showed resolution of her bilateral hydronephrosis. The nephrostomy tubes were removed. Her urine culture returned as no growth after 5 days. She was stably discharged home with clinic follow-up with general internal medicine and urology, and instructed to complete the remainder of a fourteen-day course of trimethoprim-sulfamethoxazole for complicated UTI. She was seen asymptomatically in the general internal medicine clinic one week after discharge, and chest x-ray at that time was negative for recurrence of pleural effusion.
Though rare, urinothorax belongs in the differential diagnosis of a pleural effusion, in child or adult, which has developed after (gyneco)urologic trauma or surgery, retroperitoneal surgery, or such instrumentive procedure. Management involves thoracentesis for drainage of fluid, treatment of the underlying cause, and appropriate urologic imaging and intervention targeting the reason for occurrence.
Urinothorax is a rare cause of pleural effusion which, in a limited number of case reports, has been found to occur after urologic trauma, surgery, or manipulation. In review of limited number of case reports, genitourinary symptoms are common, however, respiratory symptoms are inconsistently present. Diagnosis of urinothorax is made by pleural fluid:serum creatinine ratio greater than 1.0. In conclusion, urinothorax, while rare, should be considered in the diagnosis of a pleural effusion occurring secondary to genitourinary trauma, surgery, or intervention, as its prompt diagnosis will aid in the timely recovery of the patient.
To cite this abstract:
AN UNUSUAL CAUSE OF DYSPNEA IN A 16-YEAR-OLD PRIMIGRAVID WOMAN.
Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev..
Abstract 674Journal of Hospital Medicine Volume 12 Suppl 2.
https://shmabstracts.org/abstract/an-unusual-cause-of-dyspnea-in-a-16-year-old-primigravid-woman/.
May 3rd 2024.