Pleural empyema secondary to nephropleural fistula in complicated pyonephrosis

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

Radiology Case Reports (Sep 2021)

Pleural empyema secondary to nephropleural fistula in complicated pyonephrosis

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

Affiliations

Stefania Tamburrini, MD: Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy; Corresponding author.
Marina Lugarà, MD: Department of Internal Medicine, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
Pietro Paolo Saturnino, MD: Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
Giovanni Ferrandino, MD: Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
Pasquale Quassone, MD: Department of Radiology, ''Università degli Studi della Campania Luigi Vanvitelli'', Naples, Italy
Silvio Leboffe, MD: Department of Radiology, ''Università degli Studi della Campania Luigi Vanvitelli'', Naples, Italy
Giuseppe Sarti, MD: Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
Concetta Rocco, MD: Department of Radiology, ''Università degli Studi della Campania Luigi Vanvitelli'', Naples, Italy
Claudio Panico, MD: Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
Francesco Raffaele, MD: Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
Teresa Cesarano, MD: Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
Michele Iannuzzi, MD: Department of Anesthesiology and Intensive Care, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
Lucio Cagini, MD: Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
Ines Marano, MD: Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy

Journal volume & issue: Vol. 16, no. 9
pp. 2714 – 2718

Abstract

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Pleural empyema of extra pulmonary origin is uncommon and empyema secondary to a fistula between the urinary tract and thorax is extremely rare. We report a case of nephropleural fistula causing massive pleural empyema in a 64-year-old woman with a long history of urological problems, including nephrolitiasis and urinary tract infection. She was admitted with sepsis, fever, chills, tachypnea, productive cough and pyuria. At clinical examination, breath sounds were reduced over the left hemithorax. CT revealed a fistulous connection from the upper left calyceal group and the pleural space. Drainage of thoracic and perinephric collection was carried out, but nephrectomy and pleural decortication were required due to haemopurulent urine and decreased hemoglobin levels during the hospitalization. This case demonstrates the unusual and prolonged evolution of an obstructive hydroureteronephrosis complicated by pyonephrosis, culminating in retroperitoneal abscess that fistulized into the pleural space, leading to empyema.

Published in Radiology Case Reports

ISSN: 1930-0433 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine
Website: https://www.sciencedirect.com/journal/radiology-case-reports

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