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Rupture of the ureter in the absence of demonstrable cause is deemed spontaneous rupture. While urinothorax is a rare complication, it occurs in the following predisposing factors: external trauma, ureteral instrumentation, previous ureteral surgery, destructive ureteral disease, external compression or obstruction from stones. The above factors may produce retroperitoneal urinoma to make urinothorax. It has a clinical picture of respiratory embarrassment. Urinothorax demonstrates a significant elevation of pleural fluid creatinine and declination of glucose concentration as compared with the serum level. In many cases a temporary or permanent urinary diversion may resolve the urinothorax, then an indirect diagnosis of the urinothorax may be made. We report a case of spontaneous rupture of the ureter with urinothorax.