Adam Austin

The Urinothorax: A Comprehensive Review With Case Series☆

Abstract Urinothorax is an uncommon thoracic complication of genitourinary (GU) tract disease, which is most frequently caused by obstructive uropathy, but may also occur as a result of iatrogenic or traumatic GU injury. It is underrecognized because of a perceived notion as to the rarity of the diagnosis and the absence of established diagnostic criteria. Urinothorax is typically described as a paucicellular, transudative pleural effusion with a pleural fluid/serum creatinine ratio >1.0. It is the only transudate associated with pleural fluid acidosis (pH < 7.40). When the pleural fluid analysis demonstrates features of a transudate, pH <7.40 and a pleural fluid/serum creatinine ratio >1.0, a confident clinical diagnosis of urinothorax can be established. A technetium 99m renal scan can be considered a confirmatory test in patients who lack the typical pleural fluid analysis features or fail to demonstrate evidence of obstructive uropathy that can be identified via conventional radiographic modalities. Management of a urinothorax requires a multidisciplinary approach with an emphasis on the correction of the underlying GU tract pathology, and once corrected, this often leads to a rapid resolution of the pleural effusion.

Sevoflurane Induced Diffuse Alveolar Hemorrhage in a young patient

We report a very rare case of Sevoflurane Induced Diffuse Alveolar Hemorrhage in a previously healthy young adult in the post-operative period following general anesthesia. Diffuse alveolar hemorrhage (DAH) associated with inhalation injury from halogenated gases is a unique entity in the literature that practicing clinicians should be cognizant of and considered in post-operative cases of acute respiratory distress whereby other etiologies have been excluded.

Chronic lower back pain in a young adult

A 25-year-old man was referred to a rheumatologist with a 10-year history of progressive lower back and bilateral hip pain (right more than left). The pain had an insidious onset in his teens, which was associated with morning stiffness lasting 10–20 min in duration. The pain was worsened with physical activity and improved with rest. There was no history of preceding trauma. There was no pain noted upon extended periods of standing, bending forward or transitioning from sitting to standing position. The patient had been treated by a local chiropractor initially and then with oral acetaminophen with some relief. A trial of non-steroidal anti-inflammatory drugs (NSAIDs) was not performed prior to presentation. There was no history of constitutional symptoms, pathological fractures, visual changes or hearing loss. The patient denied any limb weakness, paresthesia, or urinary or bowel incontinence. No history of uveitis, cutaneous lesions or diarrheal illness was reported. The patient’s past medical, family and social history were noncontributory. On physical examination, the patient had an antalgic gait and a negative Schober’s test. Hip internal rotation was significantly limited bilaterally. There was no visible enlargement of the skull. The remainder of the physical examination was unremarkable. Laboratory testing demonstrated normal complete blood count and comprehensive metabolic panel. Serum C-reactive protein and erythrocyte sedimentation rate were within normal limits. The patient had a negative analysis for human leukocyte antigen (HLA)-B27, rheumatoid factor and anti-nuclear antibodies. Serum calcium, phosphorus, alkaline phosphatase and intact parathyroid hormone levels were all normal.