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Case Reports
. 2020 Sep 15;15(11):2348-2352.
doi: 10.1016/j.radcr.2020.09.013. eCollection 2020 Nov.

Urinothorax following percutaneous image-guided renal cryoablation

Helen Ng  1 , Kaiwen Wang  1 , Jon Cartledge  2 , Chandra Shekhar Biyani  2 , Christy Ralph  3 , Satinder Jagdev  3 , Naveen Vasudev  3 , Selina Bhattarai  4 , Bobby Bhartia  5 , James Lenton  5 , Jonathan Smith  5 , Simon Whiteley  6 , Peter Tcherveniakov  7 , Tze Min Wah  5
Affiliations
Case Reports

Urinothorax following percutaneous image-guided renal cryoablation

Helen Ng et al. Radiol Case Rep. .

Abstract

A 69-year-old lady with 2 renal cell carcinomas, one sited at the upper pole of her solitary right kidney, underwent percutaneous image-guided cryoablation and developed urinothorax as a complication. This was diagnosed from pleural fluid analysis and radiology imaging with computed tomography (CT). Management included image-guided chest drain and retrograde ureteric stent insertion to divert the urine from entering the pleural cavity. CT images demonstrated a fistula between the site of renal puncture and the pleural cavity, indicating that the cryoprobes traversed the diaphragm during the procedure. This case highlights urinothorax as an unusual complication of cryoablation of renal cell carcinoma. Prompt diagnosis by interventional radiologists is crucial to avert from this potentially life-threatening complication.

Keywords: Complication; Cryoablation; Renal cell carcinoma; Solitary kidney; Urinothorax.

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Figures

Fig 1
Fig. 1
(a) Axial and (b) sagittal contrast-enhanced CT showed the right upper pole RCC (horizontal arrow) and its relation to the diaphragm (vertical arrow).
Fig 2
Fig. 2
(a) Axial contrast-enhanced CT showed an avidly enhancing right upper pole RCC (vertical arrow) and (b) ice ball formation with water density Hounsfield Unit (HU) during image-guided Cryoablation (CRYO) treatment following cryoprobes insertion, where the cryoprobes have been shown to pass through the diaphragm and costophrenic space.
Fig 3
Fig. 3
Coronal non–contrast-enhanced CT chest and abdomen showed a small pleural effusion (horizontal arrow) and post-renal ablation changes, for example, perirenal haematoma (vertical arrow).
Fig 4
Fig. 4
(a) Axial contrast-enhanced CT during delay excretory phase showed contrast-enhanced urine leaking from the right upper pole calyx (horizontal arrow) into the (b) pleural cavity (vertical arrow).
Fig 5
Fig. 5
Axial contrast-enhanced CT during excretory phase showed that the reno-pleural fistula had healed (horizontal arrow), 1 month after retrograde ureteric stent insertion.
See this image and copyright information in PMC

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