Urinothorax and pseudo-azotemia following total abdominal hysterectomy: a case report.

Background: Pleural effusion is a common pulmonary condition affecting millions of individuals worldwide. Pleural effusion of extravascular origin (PEEVO) pertains to a pleural effusion that does not originate from the pulmonary vasculature. True prevalence of PEEVO, such as urinothorax, is unclear in view of the absence of clear diagnostic criteria. However, it has been observed to follow a bimodal age distribution, with a higher frequency in the age groups of 41-50 and 61-70 years. Additionally, it was more likely to have a unilateral right-sided presentation and occupy over two-thirds of the hemithorax. Pseudo-azotemia is a condition that causes elevated blood urea nitrogen (BUN) and creatinine (Cr) levels without actual kidney dysfunction. Case Description: We report an uncommon case of right-sided urinothorax in a middle-aged female presenting with symptoms of postoperative ileus after undergoing total abdominal hysterectomy. She subsequently developed pseudo-azotemia and right-sided pleural effusion. The patient was successfully treated with thoracentesis and chest tube placement, with prompt resolution of effusion and pseudo-azotemia. Conclusions: We aim to provide insights into the underlying pathophysiology as well as diagnostic and therapeutic modalities of urinothorax. Prompt recognition and intervention can improve outcomes by decreasing respiratory complications and shorten or avoid intensive care unit stays. Physicians should consider PEEVO within their differential when intrathoracic causes of pleural effusion have been excluded and be equipped to manage it appropriately.

Line it up-Inadvertent placement of nasogastric tube in pleural space resulting in iatrogenic empyema.

Dobhoff tubes, used for post-pyloric feedings, have a weighted metal end with a small diameter that enhances their flexibility to traverse the gastrointestinal tract. Unfortunately, the metal stylet can iatrogenically perforate surrounding structures in patients with diminished cough and gag (1), and extreme caution should be considered before its utilization.

Postobstructive pneumonia in lung cancer.

Postobstructive pneumonia can complicate lung cancer, particularly in more advanced stages of the disease, producing significant clinical decline and a poorer prognosis. It can lead to complications such as empyema, lung abscess and fistula formation. Postobstructive pneumonia can also be the first manifestation of an underlying malignancy. There are multiple challenges in the management of these patients. Recognition and treatment of this entity can be complex and includes the use of imaging, administration of broad-spectrum antibiotics to cover the wide variety of microorganisms involved and the use of different interventional modalities to relieve the obstruction. Existing literature on postobstructive pneumonia is scarce. In this article, we review the pathophysiology, different diagnostic methods and the therapeutic options to treat this condition. The utility and efficacy of the various modalities that are currently available in clinical practice to the interventional pulmonologist are described in some detail.