Urinothorax: A Less Common Cause: Case Report

Urinothorax, an uncommon condition characterized by urine accumulation in the pleural space, poses a diagnostic and therapeutic challenge due to its rarity and potentially life-threatening consequences if not promptly addressed. We present a case of a 79-year-old female with a history of chronic kidney disease, hypertensive cardiopathy, arrhythmia, and type 2 diabetes, who presented with hemi-thoracic pain and dyspnea. Initial evaluation revealed a large left pleural effusion, later confirmed as urinothorax secondary to emphysematous pyelonephritis. The diagnostic process involved thoracic drain placement, laboratory tests, and imaging studies, including chest and abdominal CT scans. The underlying mechanism of urinothorax in this case was attributed to obstructive renal dilation causing perirenal inflammation, leading to weakened diaphragmatic barriers facilitating urine transmigration into the pleural space. Management strategies focused on treating the obstructive uropathy and relieving the underlying genitourinary tract pathology. Despite these efforts, the patient succumbed to severe sepsis. Our case underscores the importance of early diagnosis and management of urinothorax, especially in patients with urinartract disorders or recent abdominal surgeries. While urinothorax is a rare entity, clinicians should maintain a high index of suspicion to prevent delays in treatment, recognizing that timely intervention is crucial for favorable outcomes. Further research is warranted to elucidate optimal management strategies and improve prognosis in such cases.