Delayed massive haemothorax 10 days following percutaneous nephrolithotomy

Area of Science:

• Urology
• Thoracic Surgery
• Nephrology

Background:

• Percutaneous nephrolithotomy (PCNL) is a standard procedure for managing large renal stones.
• Supracostal access during PCNL increases the risk of thoracic complications.
• Patient management involves careful consideration of anticoagulation and potential bleeding risks.

Observation:

• A 56-year-old male developed a massive right haemothorax 10 days post-PCNL for complex renal stones.
• The patient had undergone coronary stenting 7 months prior and was on antiplatelet medication.
• Symptoms included cough, fever, and acute dyspnea, with imaging confirming significant hemothorax.

Findings:

• Massive right haemothorax occurred 10 days after PCNL with supracostal access.
• Delayed secondary hemorrhage was suspected, potentially linked to infection and early antiplatelet resumption.
• Intercostal drainage of 2 liters resulted in prompt recovery.

Implications:

• Haemothorax is a rare but serious delayed complication of PCNL, particularly with supracostal tracts.
• Factors such as pleural injury, infection, and antiplatelet therapy may contribute to delayed bleeding.
• Awareness and vigilant monitoring are crucial for early diagnosis and management of post-PCNL haemothorax.