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Nephrobronchial fistula and lung abscess resulting from nephrolithiasis and pyelonephritis
1Department of Internal Medicine, Washington University School of Medicine, St Louis, MO 63110, USA.
Abstract:
There are multiple etiologies reported as causes of lung abscess; however, this differential rarely includes intra-abdominal abnormalities other than extension of a hepatic process. We describe a patient who was found to have a lung abscess and empyema resulting from the development of a nephrobronchial fistula secondary to nephrolithiasis and pyelonephritis. The patient had no urinary symptoms or known abdominopelvic infection and the etiology of lung abscess was only incidentally discovered after chest CT revealed extension of pleural fluid below the diaphragm.
Insights
A rare cause of lung abscess is a nephrobronchial fistula, originating from kidney infection and stones. This case highlights the importance of considering intra-abdominal sources for thoracic infections.
Area of Science:
- Nephrology
- Pulmonology
- Infectious Diseases
Background:
- Lung abscesses typically arise from aspiration or contiguous spread from thoracic infections.
- Intra-abdominal causes are uncommon, usually limited to hepatic abscesses extending into the thorax.
Observation:
- A patient presented with lung abscess and empyema.
- The patient had no initial urinary or abdominal symptoms.
- Chest CT revealed pleural fluid extending below the diaphragm.
Findings:
- A nephrobronchial fistula was identified as the cause.
- This fistula resulted from nephrolithiasis (kidney stones) and pyelonephritis (kidney infection).
- The intra-abdominal origin was an incidental finding.
Implications:
- This case expands the differential diagnosis for lung abscesses.
- It underscores the need to investigate potential intra-abdominal sources, even without typical symptoms.
- Early recognition of nephrobronchial fistulas can prevent severe thoracic complications.