Neonatal “urinothorax” associated with posterior urethral valves

Newborn infants with posterior urethral valves usually present clinically with non-specific symptoms and signs (Williams, 1968). Radiographic findings, however, are usually confined to the urinary tract. An exception is massive ascites, which is a rare complication of posterior urethral valves or other lesions causing bladder outlet obstruction (see Bibliography). Another non-urinary tract radiographic finding which we encountered in a newborn baby with posterior urethral valves was a large pleural effusion. Abnormal amounts of urea nitrogen were present in the pleural fluid, suggesting that it contained urine. This occurrence has not been reported previously. The patient, a newborn male, was the product of a normal pregnancy, birth and delivery of a Gravida 5 Para 4 mother. Birth weight was 5 lb. 4 oz. During the first three weeks of life the infant did not gain weight and gradually developed dyspnoea and cyanosis. The mother noted constant dribbling of urine and observed that the infant did not void in a stream On admission to another hospital at the age of three weeks, the infant was found to be dyspnoeic and cyanosed. A large left pleural effusion, confirmed by chest radiographs, was present. This effusion was tapped on three occasions; 35, 95, and 105 ml., respectively, of sterile, straw-coloured fluid were withdrawn.