Pleural empyema secondary to nephropleural fistula in complicated pyonephrosis

Tamburrini, Stefania; Lugarà, Marina; Saturnino, Pietro Paolo; Ferrandino, Giovanni; Quassone, Pasquale; Leboffe, Silvio; Sarti, Giuseppe; Rocco, Concetta; Panico, Claudio; Raffaele, Francesco; Cesarano, Teresa; Iannuzzi, Michele; Cagini, Lucio; Marano, I.

doi:10.1016/j.radcr.2021.06.051

Cited by 6 publications

(6 citation statements)

References 33 publications

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“…Transdiaphragmatic fistula is a rare condition that can present as a thoracic extension of abdominal diseases [ 1 , 3 , 4 ]. TBF is a pathological entity classified under HTF that consists of abnormal communication between the thorax and the biliary tract, and it is associated with a high mortality and morbidity rate.…”

Section: Resultsmentioning

confidence: 99%

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Case Series of MRI and CT Assessment of Acquired Hepato-Biliary and Pancreatic Transdiaphragmatic Fistulae

Picchi¹,

Lassandro²,

Comune

et al. 2023

Tomography

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Transdiaphragmatic fistulae are rare conditions characterized by pathological communication between two epithelium-lined surfaces. Hepato-thoracic fistula consists of abnormal communication between the liver and/or the biliary system and the thorax; while the pancreaticopleural fistula consists of abnormal communication between the pancreas and the thorax, the pleuro-biliary fistula represents the more common type. Clinical symptoms and laboratory findings are generally non-specific (e.g., thoracic and abdominal pain, dyspnea, cough, neutrophilia, elevated CPR, and bilirubin values) and initially, first-level investigations, such as chest RX and abdominal ultrasound, are generally inconclusive for the diagnosis. Contrast-enhanced CT represents the first two-level radiological imaging technique, usually performed to identify and evaluate the underlying pathology sustained by transdiaphragmatic fistulae, their complications, and the evaluation of the fistulous tract. When the CT remains inconclusive, other techniques such as MRI and MRCP can be performed. A prompt and accurate diagnosis is crucial because the recognition of fistulae and the precise definition of the fistulous tract have a major impact on the management acquisition process.

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Section: Resultsmentioning

confidence: 99%

“…Transdiaphragmatic fistulae are rare conditions characterized by pathological communications between two epithelium-lined surfaces and can be congenital or acquired [ 1 , 2 , 3 , 4 ]. When fistulae occur across the diaphragm, abdominal disease processes can extend into the thorax and vice versa [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Case Series of MRI and CT Assessment of Acquired Hepato-Biliary and Pancreatic Transdiaphragmatic Fistulae

Picchi¹,

Lassandro²,

Comune

et al. 2023

Tomography

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“…It usually results from the spread of infection from a proximal source and is frequently linked to lung infections. Even though extra-pulmonary empyema is uncommon, cases resulting from a fistula connecting the thorax and urinary system are extremely unusual clinical phenomena, even though up to 20% of renal infections may have pulmonary consequences [ 2 ]. Empyema is characterized by the macroscopic presence of leukocytes and the appearance of thick, turbid pleural fluid.…”

Section: Discussionmentioning

confidence: 99%

“…The pelvicalyceal system and pleural cavity communicate directly and persistently in this state [ 1 ]. Trauma resulting from percutaneous renal access is often implicated as a probable cause for the development of such a fistulous connection [ 2 ]. Typical symptoms include shortness of breath, pleuritic chest pain, and pleural effusion.…”

Section: Introductionmentioning

confidence: 99%

Empyema Resulting From a Nephro-Pleural Fistula in an Adult With Polycystic Kidney Disease With Obstructive Uropathy

Mehta,

Nangia,

Gandhi

et al. 2024

Cureus

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Nephropleural fistula, a rare complication of percutaneous nephrolithotomy (PCNL), occurred in a 45-year-old male with adult autosomal dominant polycystic kidney disease (ADPKD). The patient had undergone right PCNL in 2021 and 2023 and presented to the emergency department with symptoms of fever, breathlessness, and cough lasting one week. Imaging studies, including chest radiograph and contrast-enhanced computed tomography (CECT) of the abdomen and pelvis, revealed gross right pleural effusion, right perinephric abscess, multiple renal cysts, right renal calculi and right ureteric calculi causing severe right hydronephrosis and proximal hydroureter. The imaging also confirmed a nephropleural fistula, with the right kidney's perinephric abscess communicating with the right pleura via the right subhepatic space. Subsequent thoracic ultrasound showed a large effusion of 1500ml with underlying lung collapse. Diagnostic thoracocentesis confirmed empyema, necessitating immediate tube thoracostomy. CT intravenous urography confirmed a non-functioning right kidney. The perinephric abscess was drained with a PCNL tube and meanwhile, pleural fluid and perinephric abscess isolated Klebsiella pneumonia on cultures. The patient received parenteral antibiotics and intravenous fluids and had an intercostal drain and PCNL tube in place for drainage. A right nephrectomy was recommended due to the non-functioning right kidney and the patient is awaiting the procedure.

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“…Any infectious process that spreads to the psoas muscle can progress into the posterior mediastinum and cause pleural complications [5][6][7][8][9]. Several routes and mechanisms have been described such as direct erosion through the diaphragm, trans-diaphragmatic migration of infected abdominal fluid, or as insinuated this case, a probable congenital diaphragmatic defect which is the proposed route for ascending retroperitoneal infection into the thoracic cavity causing empyema thoracis and subsequently empyema necessitans (Figures 5,6) [5][6][7]. Empyema thoracis is defined by the presence of frank pus in the pleural space and commonly from extension of a pulmonary infection.…”

Section: Discussionmentioning

confidence: 99%

Perinephric and psoas abscesses leading to empyema: An unusual tuberculosis presentation

Luke D Yap,

L Aspirin

2023

Open J Clin Med Case Rep

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Tuberculous psoas abscess usually results from tuberculous spondylitis but may also develop from direct spread or via hematogenous route [1]. Our case involves direct spread from an adjacent perinephric abscess with associated thoracic extension from suspected direct erosion or a diaphragmatic defect. We present a case of pleural empyema arising from abdominal tuberculous abscesses. This is an 11-year-old male who initially presented with a three-week history of cough, intermittent fever, and dyspnea. Congenital diaphragmatic hernia was first suspected at the emergency department when an opacified left hemithorax with cystic lucencies was noted. Further imaging of the chest and upper abdomen was done in our institution revealing large left perinephric and psoas abscesses with intra-thoracic extension resulting in empyema thoracis and necessitans. Culture of the abscess fluid yielded no growth but GenExpert tested positive for M. tuberculosis. Tuberculosis remains a major illness in developing countries and has a multitude of infection sites and clinical presentation. Our case presented as an ascending thoracic extension of a perinephric and psoas abscess, likely from a diaphragmatic defect. The absence of spinal involvement proves its renal origin. The importance of CT scan is highlighted in medically-confounding cases such as this one.

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Pleural empyema secondary to nephropleural fistula in complicated pyonephrosis

Cited by 6 publications

References 33 publications

Case Series of MRI and CT Assessment of Acquired Hepato-Biliary and Pancreatic Transdiaphragmatic Fistulae

Case Series of MRI and CT Assessment of Acquired Hepato-Biliary and Pancreatic Transdiaphragmatic Fistulae

Empyema Resulting From a Nephro-Pleural Fistula in an Adult With Polycystic Kidney Disease With Obstructive Uropathy

Perinephric and psoas abscesses leading to empyema: An unusual tuberculosis presentation

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