Nephrobronchial Fistula

Abstract

A 26-year-old woman presented with a six-year history of right staghorn calculus and pyonephrosis. Intravenous pyelography showed a non-functioning right kidney and chest radiography, an elevated right hemidiaphragm and fluid in the right costaphrenic space. At operation a nephrobronchial fistula was found, and nephrectomy and subdiaphragmatic drainage of the lung abscess was carried out. Culture of the pus grew Proteus mirabilis. The patient made an uneventful recovery and was discharged on the sixteenth day after operation.

Nephrobronchial fistula – A case report

“…While some of these patients respond to antibiotic therapy, as did ours, surgical drainage or nephrectomy remain the cornerstone of treatment [6]. However, a nephrectomy may be complicated by possible respiratory complications intra-and post-operatively [7]. Our report confirms that PUJ obstruction may predispose to empyema or lung abscess by way of pyonephrosis.…”

Empyema and Respiratory Failure Secondary to Nephropleural Fistula Caused by Chronic Urinary Tract Infection: A Case Report

“…Empyema developing secondary to a nephropleural fistula tends to involve those organisms that cause upper urinary tract infections, for example, Gram-negative facultative anaerobes such as Escherichia coli and Proteus mirabilis [9]—both of which have also been implicated in the development of xanthogranulomatous pyelonephritis, a condition that is reported to be particularly prone to causing fistula that crosses the diaphragm [10–12]. Mycobacterial infections have also been implicated in the formation of pathological communications between the renal tract and thorax [13] and were identified by Aly et al as aetiological in almost 20% of cases of nephrobronchocutaneous fistula of which there are less than one hundred cases reported in the literature [14].…”

Empiema pleural masivo secundario a pionefrosis

“…Si bien el desarrollo de lesiones pulmonares secundarias a procesos provenientes del área renal o perirrenal es muy frecuente, llegando incluso al 70-85% de los casos (3), en general son pequeñas atelectasias o derrames pleurales mínimos, que se suelen resolver sin complicaciones tras la curación del proceso inicial. Sólo en pocas ocasiones las lesiones son más graves, habiéndose descrito empiemas masivos (4-6) como el de nuestra paciente, fístulas nefrobronquiales (7,8) o abscesos pulmonares (8) secundarios a procesos inflamatorios homolaterales del riñón y tejidos pararrenales, que añaden la dificultad suplementaria de ser en ocasiones silentes o subclínicos, (5,6,8) y cuyo primer síntoma es el torácico. Es por ello, que ante un empiema cuya etiología no esté bien aclarada, debe hacerse diagnóstico diferencial de las causas subdiafragmáticas del mismo, que aunque infrecuentes, siguen siendo un origen potencial.…”