Urinothorax, another complication of bladder tumor: case report

Saleh Abdelkerim Nedjim,Adil Debbagh,Mohamed Dakir,Amine Moataz,El Mostapha Abdi,Rachid Aboutaieb,Hissein Hagguir

doi:10.1186/s12301-021-00228-9

Saleh Abdelkerim Nedjim, Adil Debbagh + Show 5 more

Open Access

https://doi.org/10.1186/s12301-021-00228-9

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Abstract

BackgroundRupture of the fornix is a rare and serious urological complication of obstructive pathologies. The main cause is ureteral stone, but rarely a bladder tumor. Described complications of fornix rupture are superinfection, perirenal abscesses and even sepsis, but not urinothorax.Case presentationPatient of 56 years old, active and chronic smoker, was hospitalized for anemia and obstructive renal failure on a non-documented bladder tumor; clinically, he was presented with hematuria and an intense right loin pain associated with homolateral basithoracic pain and dyspnea. The CT scan without injection showed a right perirenal collection with bilateral renal dilatation on endo-vesical tumor and a right pleural effusion of less abundance. The ratio of pleural fluid creatinine to blood creatinine was greater than 1, confirming urinothorax. As an emergency, a percutaneous nephrostomy was performed. After clinical stabilization, the patient underwent a trans-urethral resection of the bladder and derivation by a double j stent. The ultimate evolution was favorable.ConclusionsBeyond the metabolic complications secondary to obstructions, mechanical complications, which can also be fatal, must be included.

Highlights

Rupture of the fornix is a rare and serious urological complication of obstructive pathologies
Emergency treatment consists of a urinary diversion
A CT scan without injection of iodinated contrast confirmed the presence of a right perirenal collection with bilateral ureterohydronephrosis (Fig. 1) on a heterogeneous intravesical tumor (Fig. 2) and a right sided pleural effusion of a small amount (Fig. 3)

Summary

Background

Rupture of the fornix is a rare urological complication of obstructive pathologies, most often secondary to an obstructive urolithiasis but rarely to be tumoral in origin. We are reporting a first clinical case of urinothorax secondary to fornix rupture due to bladder tumor. A CT scan without injection of iodinated contrast confirmed the presence of a right perirenal collection with bilateral ureterohydronephrosis (Fig. 1) on a heterogeneous intravesical tumor (Fig. 2) and a right sided pleural effusion of a small amount (Fig. 3). The emergency management plan started by bladder catheterization and declotting, an intravenous access for rehydration and antibiotic therapy, transfusion and bilateral percutaneous nephrostomy. A transurethral bladder tumor resection was performed with bilateral double J-tube stent. The histopathological study of the resection cuts confirmed a high-grade urothelial bladder carcinoma infiltrating the lamina propria

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