Urinothorax occurring in conjunction with intraperitoneal bladder rupture
Cressman S, and Rheinboldt M. Urinothorax occurring in conjunction with intraperitoneal bladder rupture. Appl Radiol 2018; 47(5).
A 45-year-old female presented to the emergency department with acute onset suprapubic crampy abdominal pain and increased urinary urgency and frequency. Pertinent medical history included prior resection of a benign, non-specified bladder mass two years previously at an outside institution. Review of systems and physical examination were unremarkable with the exception of diffuse lower abdominal tenderness without rebound. Laboratory results including urinalysis and vaginal wet prep were negative. Transabdominal and endovaginal pelvic ultrasound was unremarkable. Subsequently, a contrast-enhanced abdominal and pelvic CT scan was performed, demonstrating a focal fluid collection contiguous with the bladder dome felt to represent a congenital or acquired/post-operative bladder diverticulum or atypical urachal remnant. The patient was discharged but returned two days later with shortness of breath and abdominal distention. A new large right-sided pleural effusion was observed, ultimately confirmed to be a urinothorax secondary to bladder dome rupture at site of prior surgery.