Systemic Inflammatory Response Syndrome after Massive Extravasation into the Pleural Space of Contrast Medium during Supracostal Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy is indicated for renal stones larger than 2 cm and upper ureteral stones not amenable to retrograde management. Supracostal access may enable better access to the entire collecting system and even be preferential in some cases, although having a higher risk of pleural or lung injury, resulting in hydrothorax or pneumothorax. We report a case of a patient who developed a massive hydrothorax during surgery. In this particular case the hydrothorax was mainly composed of iodixanol (visipaque®) isosmolar nonionic contrast media. We assume that this was the reason why a subsequent systemic inflammatory response syndrome (SIRS) was observed. There is no reference in the literature to a prolonged SIRS associated to a hydrothorax mainly composed of nonionic contrast media following a supracostal percutaneous nephrolitotomy.