Tan Pei Sze Carmen, Badiei Arash, Fitzgerald Deirdre B, Kuok Yi Jin, Lee Y C Gary
Department of Respiratory Medicine Sir Charles Gairdner Hospital Nedlands Western Australia Australia.
Department of Respiratory and Critical Care Medicine Tan Tock Seng Hospital Singapore Singapore.
Respirol Case Rep. 2019 Jan 29;7(3):e00400. doi: 10.1002/rcr2.400. eCollection 2019 Apr.
Pleural infection as a complication of ascending urological infection is rare, and the mechanism often unclear. We report a complicated case of pleural infection and perinephric abscess in a patient who presented with a large right-sided pleural effusion. Pleural fluid culture yielded , an unusual pathogen in pleuro-pulmonary infections. Her computed tomography (CT) scan of abdomen showed a right perinephric abscess which extended into the pleural cavity. Review of prior CT imaging suggested a pre-existing diaphragmatic defect, likely representing a congenital Bochdalek foramen, through which the infection ascended. Successful treatment was achieved with systemic antibiotics, and drainage of both the pleural and retroperitoneal collections. Intra-pleural tissue plasminogen activator/deoxyribonuclease therapy effectively cleared the residual pleural fluid. Spread of intra-abdominal sepsis through diaphragmatic defects to the pleural cavity represents a potential source of empyema.
作为上行性泌尿系统感染并发症的胸膜感染很少见，其机制通常不明。我们报告一例复杂的胸膜感染和肾周脓肿病例，患者表现为右侧大量胸腔积液。胸腔积液培养分离出一种在胸膜肺部感染中不常见的病原体。她的腹部计算机断层扫描（CT）显示右肾周脓肿延伸至胸腔。回顾之前的CT影像提示存在一个先前就有的膈肌缺损，可能代表先天性Bochdalek孔，感染由此上行。通过全身使用抗生素以及对胸腔和腹膜后积液进行引流，治疗取得成功。胸腔内组织纤溶酶原激活剂/脱氧核糖核酸酶治疗有效清除了残留的胸腔积液。腹腔内感染通过膈肌缺损蔓延至胸腔是脓胸的一个潜在来源。
