Nephrobronchial fistula and lung abscess secondary to Xanthogranulomatous pyelonephritis

Abstract

There are multiple causes of lung abscess, but the differential rarely includes pyelonephritis as a primary cause leading to lung abscess resulting from the development of a nephrobronchial fistula. The patient had no urinary symptoms or abdominal pain and the etiology of lung abscess was only incidentally discovered after chest CT revealed extension of pleural fluid below the diaphragm.

Case of nephropulmonary fistula and literature review

“…Case reports supported the heterogeneous clinical presentations of nephropulmonary fistula, 1 ranging from urinary symptoms like pyelonephritis; to respiratory symptoms like dry cough for weeks or months, 2 , 3 or acute respiratory arrest with mucus bronchial blockage 4 ; to cutaneous symptoms like discharging sinus with nephrobronchial-cutaneous fistula.…”

“…Concerning the management of the fistula tract, some authors plicated or ligated the fistula tract, 2 , 4 some would put in a drain through the fistula tract and remove post-operatively when output is reduced 5 (also in our case).…”

“…Concerning the airway management, if nephropulmonary fistula is suspected pre-operatively, Uppe suggested for double lumen endotracheal tube with double lung ventilation 2 . With the presence of double lumen tube in the bronchus, any spillage of pus on the handling kidney can be sucked out through the ipsilateral bronchus, preventing spillage towards the healthy contralateral bronchus.…”

Xanthogranulomatous Pyelonephritis: Synchronous Upper and Lower Gastrointestinal Bleed

“…Fistulas connecting the kidney to the colon, jejunum, duodenum, bronchus, diaphragm, thorax, psoas muscle, and skin were reported. 4-12…”

“…Fistulas connecting the kidney to the colon, jejunum, duodenum, bronchus, diaphragm, thorax, psoas muscle, and skin were reported. [4][5][6][7][8][9][10][11][12] There are no reported cases of concurrent reno-gastric and reno-colic fistulas. Herein, we describe a unique case of reno-gastric and reno-colic fistulas in a patient with history of left renal calculus presenting with simultaneous upper and lower gastrointestinal bleed.…”