CHEST Guidelines-A-54-Year-Old-Woman-With-Shortness-of-Breath-After

A-54-Year-Old-Woman-With-Shortness-of-Breath-After

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A 54-year-old woman developed respiratory distress following nephrolithotomy through a supracostal approach. Post-surgery, she exhibited a low-grade fever, dry cough, palpitations, and shortness of breath. Physical examination showed mild fever and tachycardia, while imaging indicated a right-sided pleural effusion and a subcapsular hematoma near the nephrostomy site. Thoracentesis revealed a pleural effusion characterized by elevated creatinine levels, confirming a diagnosis of loculated urothorax.<br /><br />Urothorax, a rare complication post-genitourinary procedures, often occurs on the side of the manipulated gu tract and is typically unilateral. It results from urine leaking into the pleural space, often due to increased pressure differentials between the abdomen and chest cavity or through lymphatic drainage pathways. Its symptoms range from mild respiratory issues to severe distress and are accompanied by systemic signs like fever and fatigue. Diagnosis generally involves correlating procedure history with imaging studies and pleural fluid analysis, where a pleural fluid creatinine to serum ratio over 1 is diagnostic. <br /><br />Typically, urothorax presents as non-loculated pleural effusion, but it can occasionally be loculated due to urine mixed with inflammatory debris. Although usually not infectious, loculated effusions could complicate management, necessitating surgical intervention over conservative methods like chest tube drainage. This patient underwent surgical evacuation via video-assisted thoracoscopy after conservative management failed. The procedure resolved the effusion, and the patient recovered with continued care for a pulmonary embolism identified during her postoperative course.<br /><br />The case elucidates the importance of recognizing urothorax in patients with recent genitourinary manipulations who present with compatible symptoms. Proper history, imaging, and pleural analysis are crucial for accurate diagnosis and effective treatment.

Keywords

urothorax

pleural effusion

nephrolithotomy

supracostal approach

respiratory distress

creatinine levels

video-assisted thoracoscopy

genitourinary procedures

pulmonary embolism

pleural fluid analysis