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Urinothorax is a rare cause of pleural effusion characterized by the collection of urine in the pleural space. The index of suspicion should be higher when a pleural effusion is associated with cases of urinary tract obstruction or obstructive uropathy (renal calculi) and trauma. The characteristic feature in the diagnosis of urinothorax lies in the biochemistry, where the ratio of pleural fluid to serum creatinine is higher than 1. The present case is a unique instance of urinothorax with left urinoma and hydronephrosis where the ratio of pleural fluid to serum creatinine is below one.
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