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Pleural empyema in a patient with a perinephric abscess and diaphragmatic defect

Pei Sze Carmen Tan1,2, Arash Badiei1, Deirdre B Fitzgerald1

  • 1Department of Respiratory Medicine Sir Charles Gairdner Hospital Nedlands Western Australia Australia.

Respirology Case Reports
|February 7, 2019
PubMed

Insights

Pleural infection from ascending urological sepsis is rare. A case highlights how a congenital diaphragmatic defect allowed a perinephric abscess to cause empyema, successfully treated with antibiotics and drainage.

Area of Science:

  • Medicine
  • Infectious Diseases
  • Pulmonology

Background:

  • Pleural infection, or empyema, is uncommon as a complication of ascending urological infections.
  • The precise mechanisms driving such infections are often not fully understood.

Observation:

  • A patient presented with a large right-sided pleural effusion and was diagnosed with a right perinephric abscess.
  • Computed tomography (CT) imaging revealed the abscess extended into the pleural cavity.
  • Prior CT scans indicated a congenital Bochdalek foramen, a diaphragmatic defect, likely serving as the pathway for infection ascent.

Findings:

  • Pleural fluid culture identified *Morganella morganii*, an atypical pathogen in pleuro-pulmonary infections.
  • The patient received successful treatment involving systemic antibiotics and drainage of both pleural and retroperitoneal abscesses.
  • Intra-pleural tissue plasminogen activator/deoxyribonuclease therapy aided in clearing residual pleural fluid.

Implications:

  • Ascending intra-abdominal sepsis through diaphragmatic defects can be a source of empyema.
  • This case underscores the importance of considering unusual pathways for infection spread.
  • Prompt diagnosis and multi-modal treatment are crucial for managing complex cases of empyema linked to intra-abdominal sources.
Keywords:
Abscessdiaphragmatic defectempyemaperinephricpleural

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