Pleural effusion and ascites in extrarenal lymphangiectasia causedby post-biopsy hematoma: A case report  

作　　者：Qiong-Zhen Lin Hui-En Wang Dong Wei Yun-Feng Bao Hang Li Tao Wang 

机构地区：[1]Department of Nephrology,The Third Hospital of Hebei Medical University,Shijiazhuang 050051,Hebei Province,China [2]Department of Thoracic Surgery,Hebei Provincial General Hospital,Shijiazhuang 050051,Hebei Province,China [3]Department of Urology,Hebei Provincial General Hospital,Shijiazhuang 050051,Hebei Province,China [4]Department of Medical Imaging,Hebei General Hospital,Shijiazhuang 050051,Hebei Province,China [5]Department of Nephrology,Peking Union Medical College Hospital,Beijing 100045,China [6]Department of Nephrology,The First Hospital of Hebei Medical University,Shijiazhuang 050000,Hebei Province,China

出　　处：《World Journal of Clinical Cases》2020年第24期6330-6336,共7页世界临床病例杂志

摘　　要：BACKGROUNDThe renal system has a specific pleural effusion associated with it in the form of“urothorax”, a condition where obstructive uropathy or occlusion of thelymphatic ducts leads to extravasated fluids (urine or lymph) crossing thediaphragm via innate perforations or lymphatic channels. As a rare disorder thatmay cause pleural effusion, renal lymphangiectasia is a congenital or acquiredabnormality of the lymphatic system of the kidneys. As vaguely mentioned in areport from the American Journal of Kidney Diseases, this disorder can be causedby extrinsic compression of the kidney secondary to hemorrhage.CASE SUMMARYA 54-year-old man with biopsy-proven acute tubulointerstitial nephropathyexperienced bleeding 3 d post hoc, which, upon clinical detection, manifested as amassive perirenal hematoma on computed tomography (CT) scan withoutconcurrent pleural effusion. His situation was eventually stabilized byexpeditious management, including selective renal arterial embolization. Despite good hemodialysis adequacy and stringent volume control, a CT scan 1 mo laterfound further enlargement of the perirenal hematoma with heterogeneoushypodense fluid, left side pleural effusion and a small amount of ascites. Thesefluid collections showed a CT density of 3 Hounsfield units, and drained fluid ofthe pleural effusion revealed a dubiously light-colored transudate withlymphocytic predominance (> 80%). Similar results were found 3 mo later, duringwhich time the patient was free of pulmonary infection, cardiac dysfunction andovert hypoalbuminemia. After careful consideration and exclusion of otherpossible causative etiologies, we believed that the pleural effusion was due to theocclusion of renal lymphatic ducts by the compression of kidney parenchymaand, in the absence of typical dilation of the related ducts, considered our case asextrarenal lymphangiectasia in a broad sense.CONCLUSIONAs such, our case highlighted a morbific passage between the kidney and thoraxunder an extraordinarily rare condition. Given the paucity

关 键 词：Urothorax Pleural effusion Perirenal hematoma Renal lymphangiectasia Lymphatic drainage Case report 

分 类 号：R561.3[医药卫生—呼吸系统] R442.5[医药卫生—内科学]