Empiema pleural secundario a pionefrosis

Pérez, José María Hernández; Suárez, José P.; Gilart, Jordi Freixinet

doi:10.1157/13119945

Cited by 5 publications

(5 citation statements)

References 5 publications

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“…Tachypnea, decreased breath sounds, and diminished resonance or dullness on thoracic percussion on the affected pulmonary side may also be present [1–3, 9]. …”

Section: Discussionmentioning

confidence: 99%

“…Patients with secondary pulmonary involvement (such as our patient) may present with a productive cough, pleurodynia, or dyspnea, and, in some cases, even a urine-like taste in the mouth due to a nephrobronchial fistula. Tachypnea, decreased breath sounds, and diminished resonance or dullness on thoracic percussion on the affected pulmonary side may also be present [ 1 – 3 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, more recent cases involve enteric gram-negative agents such as Escherichia coli (14–63%), Klebsiella pneumoniae (5–25%), P. mirabilis (5–21%), and Pseudomonas aeruginosa (5–11%) [ 6 , 8 ]. In patients with nephropulmonary fistulas, the causative organisms are similar: E. coli and P. mirabilis again predominate [ 3 , 9 ]. If suspicious bacterial species such as Proteus are found in pleural liquids or respiratory secretions, associated renal disease should be excluded [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Perinephric and retroperitoneal abscesses are infrequent clinical entities. Concomitant thoracic involvement is even rarer: very few cases have been described worldwide [ 1 – 3 ]. Since their diagnosis is difficult, a rare case of a perinephric abscess that involved an even rarer complication is described here.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Kronenberg

Graça

Coelho

2014

Case Reports in Urology

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A rare case of perinephric abscess with unilateral secondary pulmonary involvement that was further complicated by spillover of purulent content into the contralateral lung is reported here. Its diagnosis, treatment, and evolution are described and discussed along with certain features of nephropulmonary fistulas. The diagnosis of these abscesses is difficult, largely because of the paucity of primary symptoms and the frequent presence of misleading secondary symptoms. Deceptive cases like this one highlight the importance of its contemplation in every physician's differential diagnosis.

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“…Tachypnea, decreased breath sounds, and diminished resonance or dullness on thoracic percussion on the affected pulmonary side may also be present [1–3, 9]. …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Kronenberg

Graça

Coelho

2014

Case Reports in Urology

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“…The correction of the underlying cause usually suffices, resulting in the spontaneous resolution of the urinothorax [5, 15]; if the pleural effusion persists, then drainage of the urine through an intercostal thoracic tube is recommended [3, 15, 16]. …”

Section: Discussionmentioning

confidence: 99%

Urinothorax—An Underdiagnosed Cause of Acute Dyspnea: Report of a Bilateral and of an Ipsilateral Urinothorax Case

Laskaridis

Kampantais

Toutziaris

et al. 2012

Case Reports in Emergency Medicine

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Urinothorax (UT) is a rare and often undiagnosed condition, defined as the presence of urine in the pleural cavity due to the retroperitoneal leakage of urine accumulation, known as urinoma, into the pleural space. UT usually is a transudative pleural effusion that presents in patients with obstructive uropathy and it may occur following surgical procedures in the ureter or kidney such as ESWL, PCNL, and URS. Its diagnosis requires a high degree of clinical suspicion since the respiratory symptoms tend to be absent or mild and the urological signs tend to dominate. However, UT may rarely present with severe and acute dyspnea as well. The objectives of this study are to describe two new cases of this rare entity, a bilateral case and an ipsilateral case focusing on the side that occurs according to the affected renal insult, and to alert the physicians to include UT in their differential diagnosis of pleural effusions especially in patients with recent urinary tract disorders.

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Proteus empyema as a rare complication from an infected renal cyst, a case report

et al. 2020

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Background The most commonly isolated organisms in a parapneumonic effusion include S. pneumoniae, H. influenzae, and S. aureus. If unusual organisms are isolated from the pleural space, further investigation is warranted to locate the primary source. We present a patient with an infected chronic renal cyst found to have an empyema secondary to Proteus mirabilis to highlight the importance of further diagnostic workup when encountering unusual organisms in the pleural space. Case presentation A 40-year-old African-American female, with a past medical history of asthma and sickle cell trait, presented with 5 weeks of upper respiratory tract symptoms and chest pain. A computed tomography angiogram (CTA) of the chest was negative for a pulmonary embolism but revealed a loculated left sided pleural effusion with associated left-lower lobe consolidation. She was started on empiric antibiotics, and a chest tube was inserted with drainage of frank pus. Fluid gram stain was positive for gram negative rods. Intrapleural fibrinolytics were administered for 72 h given the presence of loculations. With no improvement following fibrinolytics, she was taken to the operating room for large bore chest tube placement and left visceral pleura decortication. Pleural fluid cultures speciated to Proteus mirabilis, so further cross-sectional imaging of her abdomen/pelvis was pursued to evaluate for a primary source. A complex cystic lesion in the upper pole of the left kidney that communicated with the ipsilateral diaphragm was identified. Subsequent drainage and culture of the renal cyst was positive for Proteus mirabilis. Given clinical improvement following these interventions she was discharged with an extended course of antibiotics with plans for repeat imaging following completion of treatment. Conclusions While cases of Proteus mirabilis empyema have previously been reported as a consequence of conditions such as pyelonephritis, we present, to our knowledge, the first case of a Proteus mirabilis empyema as a consequence of an infected renal cyst communicating with the pleural space. This study highlights that further evaluation with cross-sectional imaging is warranted when unusual organisms are found in the pleural space. Anatomic abnormalities that become apparent on imaging may help elucidate the source of infection.

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Empiema pleural secundario a pionefrosis

Cited by 5 publications

References 5 publications

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

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

Urinothorax—An Underdiagnosed Cause of Acute Dyspnea: Report of a Bilateral and of an Ipsilateral Urinothorax Case

Proteus empyema as a rare complication from an infected renal cyst, a case report

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