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Urinothorax causing massive left side pleural effusion in a young lady; case report and literature review.

ABSTRACT: Urinothorax is the presence of the urine in the pleural space. This condition is very rare and occurs due to unrelieved obstruction of urinary flow. A 20-year-old female presented 7 days after cesarean section with tachypnea, and generalized abdominal pain. There was absent air entry over the left hemithorax. CT scan showed massive left pleural effusion and a stone obstructing the renal pelvis with hydronephrosis and peri-renal collection. The pleural fluid had high fluid creatinine level suggesting urine collection. Ureteroscopy done and double J catheter inserted. The effusion became loculated, thoracotomy and pleural decortication done.

SUBMITTER: Bahjat AS

PROVIDER: S-EPMC6612650 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Urinothorax causing massive left side pleural effusion in a young lady; case report and literature review.

Bahjat Alaa S AS Sadeeq Kamiran J KJ Tahir Ahamd Mohammad Sharif AMS Mohammed Ayad Ahmad AA

Urology case reports 20190628

Urinothorax is the presence of the urine in the pleural space. This condition is very rare and occurs due to unrelieved obstruction of urinary flow. A 20-year-old female presented 7 days after cesarean section with tachypnea, and generalized abdominal pain. There was absent air entry over the left hemithorax. CT scan showed massive left pleural effusion and a stone obstructing the renal pelvis with hydronephrosis and peri-renal collection. The pleural fluid had high fluid creatinine level sugges ...[more]

PMID: 31321210

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Project description:RationaleLevels of pleural fluid adenosine deaminase (ADA), a useful marker for the diagnosis of tuberculous pleurisy, are elevated in some reports of immunoglobulin G4 (IgG4)-related pleural effusion. We describe a patient with IgG4-related pleural effusion who exhibited a high concentration of ADA. Furthermore, we reviewed the literature to compare patients with IgG4-related pleural effusion and tuberculous pleurisy.Patient concernsA 75-year-old male patient had dyspnea for 1 month with a left pleural effusion that was exudative, lymphocyte dominant. The pleural fluid test results revealed a total protein (TP) concentration of 6.60 g/dl, a lactate dehydrogenase (LDH) level of 383 IU/dl, and an ADA concentration of 54.5 U/L. An interferon gamma release assay showed a negative result.DiagnosesHistological analysis of the thoracoscopic pleural biopsy revealed lymphoplasmacytic infiltration, with 80 IgG4-positive plasma cells/high-power field, and an IgG4/IgG ratio of approximately 40% to 50%. Other diseases were ruled out based on symptoms, negative autoimmune antigen results, and histopathologic findings. Thus, he was diagnosed with IgG4-related pleural effusion.InterventionsHe received 15 mg of prednisolone as therapy.OutcomesHis pleural effusion and symptoms improved gradually within several months, and prednisolone was tapered to 6 mg daily.LessonsIt is important to distinguish between IgG4-related pleural effusion and tuberculous pleurisy. Therefore, we compared 22 patients with IgG4-related pleural effusion from PubMed and the Japan Medical Abstracts Society to 40 patients with tuberculous pleurisy at Fukujuji Hospital from January 2017 to May 2019. According to thoracentesis findings, 14 of 18 patients with IgG4-related pleural effusion had high ADA more than 40 U/L. The pleural effusion of patients with IgG4-related pleural effusion showed higher TP levels (P < .001) and lower LDH (P < .001) and ADA levels (P = .002) than those with tuberculous pleurisy. Moreover, the pleural fluid ADA/TP ratio was a good predictor for differentiating IgG4-related pleural effusion and tuberculous pleurisy (area under the receiver operating characteristic curve of 0.909; 95% confidence level: 0.824-0.994).

Dataset Information

Urinothorax causing massive left side pleural effusion in a young lady; case report and literature review.

Publications

Urinothorax causing massive left side pleural effusion in a young lady; case report and literature review.

Similar Datasets

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