Absceso renal con perforación a tórax

Abstract

The kidney abscess and/or xanthogranulomatosis pyelonephritis are the result of a lithiasis not treated obstruction that conditions to the appearance of urinary infection and posterior pyonephrosis and or kidney abscess. The not early detection of the kidney abscess conditions to the perforation to retroperitoneal, intra-abdominal and to chest. The early treatment of the abscess (antibiotics and percutaneous drainage) it can avoid the nephrectomy.

Nephrobronchial fistula and lung abscess secondary to Xanthogranulomatous pyelonephritis

“…Xanthgranulomatous pyonephritis has previously been reported in association with lung abscess and empyema owing to its invasive nature. [ 1 2 3 ] The preference for extension of inflammation superiorly through the diaphragm was described by Evans and Co workers[ 4 ] who noted that the lines of fusion of the renal fascial planes tend to direct the exudate within the retroperitoneal compartment. These patients typically respond well to drainage and antibiotic therapy but often require nephrectomy, as in our case.…”

Giant Nephrothoracic Abscess: A Misleading Disease, a Surgical Challenge, and an Unexpected Complication

“…However, their diagnosis may become easier if one understands the routes through which these abscesses develop (which include hematogenous dissemination, ascending urinary tract infection, or via contiguity), their risk factors, and their clinical features [2, 4, 5]. …”

“…Other risk factors are diabetes, immunosuppressive conditions, intravenous drug abuse, skin infections, any cause of urinary stasis, malignancy, and prolonged antibiotic use [2, 6, 7]. …”

“…Common presenting symptoms are fever (64–94% of patients) and pain (70–87%), predominantly in the flank or abdomen. Other frequent symptoms are nausea and vomiting (30–64%), weight loss (15-16%), and chills (9–40%); however, urinary tract symptoms, such as pollakiuria and dysuria, have only been reported in 6–12% of cases [2, 7]. When distant symptomatic complications arise, the often scarce renal symptoms may be overlooked or erroneously attributed to the secondary aggravation.…”

“…Although nephron-sparing attitudes are more desirable, in case of widespread damage to the kidney parenchyma and severe septic conditions, nephrectomy is justified, such as in our case [2, 6, 7]. If the patient is too unstable for anesthesia, prompt percutaneous drainage should be attempted while postponing the open procedure for a later, more stable, setting [6].…”