Bhat Abhishek, Katz Jonathan E, Smith Nicholas, Shah Hemendra N
Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Urology, University of Miami Miller School of Medicine, Miami, Florida, USA
BMJ Case Rep. 2021 Apr 1;14(4):e241360. doi: 10.1136/bcr-2020-241360.
Nephropleural fistula is a rarely encountered complication of percutaneous nephrolithotomy (PCNL). Only 11 cases have been reported in literature to date. Often associated with supracostal punctures, the presentation is frequently delayed. Diagnosis is based on imaging, mainly X-rays and CT along with retrograde pyelography that establishes the fistulous connection. A difficult to diagnose condition, any patient with a supracostal access PCNL who presents with delayed symptoms of breathlessness and has leucocytosis with fluid in the lungs on chest imaging should be suspected to have a nephropleural fistula. The management involves intercostal tube thoracostomy to relieve symptoms and drainage of the operated kidney by double-J stent placement, if not placed already. Prompt recognition and management results in excellent recovery with no sequelae. We present our experience with two such cases and our aim was to familiarise the practising urologist regarding the diagnosis and management of this infrequent condition.
肾胸膜瘘是经皮肾镜取石术（PCNL）一种罕见的并发症。迄今为止，文献中仅报道了11例。它常与肋上穿刺相关，症状出现往往延迟。诊断基于影像学检查，主要是X线、CT以及逆行肾盂造影，后者可确定瘘管连接。这是一种难以诊断的疾病，任何接受肋上入路PCNL术后出现呼吸困难延迟症状且胸部影像学显示白细胞增多及肺部有积液的患者，都应怀疑患有肾胸膜瘘。治疗方法包括肋间置管胸廓造口术以缓解症状，若尚未放置双J管，则通过放置双J管对手术侧肾脏进行引流。及时识别和处理可使患者良好恢复且无后遗症。我们介绍了两例此类病例的经验，目的是让泌尿外科医生熟悉这种罕见疾病的诊断和治疗。
