Urinothorax demonstrated on 99mTc Ethylene dicysteine renal scintigraphy

A 35-year-old Asian male presented with complaints offever, right-sided pleuritic chest pain and shortness ofbreath of 7 days’ duration, 1 month after a rightpercutaneous nephrolithotomy (PCNL) by supracostalpuncture. On examination, the patient was pale andtachypnaeic with pulse 120/min and blood pressure150/100mm Hg. He had stony dullness with decreasedbreath sounds in the right mammary, axillary andinterscapular areas.A chest radiograph demonstrated massive right-sided pleural effusion. Thoracocentesis of the rightside of the chest yielded about 900ml of pleuralfluid, analysis of which revealed a pleural fluid:serum creatinine ratio of 58 (normal <1), pleuralfluid protein 500mg/dl and sugar 46mg/dl, with atotal leucocyte count of 3000/mm