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Mehta K, Nangia S, Gandhi R, Chaudhury S. Empyema Resulting From a Nephro-Pleural Fistula in an Adult With Polycystic Kidney Disease With Obstructive Uropathy. Cureus 2024; 16:e57671. [PMID: 38707149 PMCID: PMC11070210 DOI: 10.7759/cureus.57671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 05/07/2024] Open
Abstract
Nephropleural fistula, a rare complication of percutaneous nephrolithotomy (PCNL), occurred in a 45-year-old male with adult autosomal dominant polycystic kidney disease (ADPKD). The patient had undergone right PCNL in 2021 and 2023 and presented to the emergency department with symptoms of fever, breathlessness, and cough lasting one week. Imaging studies, including chest radiograph and contrast-enhanced computed tomography (CECT) of the abdomen and pelvis, revealed gross right pleural effusion, right perinephric abscess, multiple renal cysts, right renal calculi and right ureteric calculi causing severe right hydronephrosis and proximal hydroureter. The imaging also confirmed a nephropleural fistula, with the right kidney's perinephric abscess communicating with the right pleura via the right subhepatic space. Subsequent thoracic ultrasound showed a large effusion of 1500ml with underlying lung collapse. Diagnostic thoracocentesis confirmed empyema, necessitating immediate tube thoracostomy. CT intravenous urography confirmed a non-functioning right kidney. The perinephric abscess was drained with a PCNL tube and meanwhile, pleural fluid and perinephric abscess isolated Klebsiella pneumonia on cultures. The patient received parenteral antibiotics and intravenous fluids and had an intercostal drain and PCNL tube in place for drainage. A right nephrectomy was recommended due to the non-functioning right kidney and the patient is awaiting the procedure.
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Affiliation(s)
- Kundan Mehta
- Respiratory Medicine, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Sidhaant Nangia
- Respiratory Medicine, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Rhea Gandhi
- Respiratory Medicine, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Spandana Chaudhury
- Respiratory Medicine, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
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Picchi SG, Lassandro G, Comune R, Pezzullo F, Fiorini V, Lassandro F, Tonerini M, Masala S, Tamburro F, Scaglione M, Tamburrini S. Case Series of MRI and CT Assessment of Acquired Hepato-Biliary and Pancreatic Transdiaphragmatic Fistulae. Tomography 2023; 9:1356-1368. [PMID: 37489476 PMCID: PMC10366742 DOI: 10.3390/tomography9040108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
Transdiaphragmatic fistulae are rare conditions characterized by pathological communication between two epithelium-lined surfaces. Hepato-thoracic fistula consists of abnormal communication between the liver and/or the biliary system and the thorax; while the pancreaticopleural fistula consists of abnormal communication between the pancreas and the thorax, the pleuro-biliary fistula represents the more common type. Clinical symptoms and laboratory findings are generally non-specific (e.g., thoracic and abdominal pain, dyspnea, cough, neutrophilia, elevated CPR, and bilirubin values) and initially, first-level investigations, such as chest RX and abdominal ultrasound, are generally inconclusive for the diagnosis. Contrast-enhanced CT represents the first two-level radiological imaging technique, usually performed to identify and evaluate the underlying pathology sustained by transdiaphragmatic fistulae, their complications, and the evaluation of the fistulous tract. When the CT remains inconclusive, other techniques such as MRI and MRCP can be performed. A prompt and accurate diagnosis is crucial because the recognition of fistulae and the precise definition of the fistulous tract have a major impact on the management acquisition process.
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Affiliation(s)
- Stefano Giusto Picchi
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy
| | - Giulia Lassandro
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy
| | - Rosita Comune
- Division of Radiology, Università degli Studi della Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, 80138 Naples, Italy
| | - Filomena Pezzullo
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy
| | - Valeria Fiorini
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy
| | - Francesco Lassandro
- Department of Radiology, Ospedale S.Anna e SS. Madonna della Neve, ASL NA3 Sud, Via Lenze, Boscotrecase, 80042 Naples, Italy
| | - Michele Tonerini
- Department of Emergency Radiology, Cisanello Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Salvatore Masala
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Fabio Tamburro
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
- Department of Radiology, James Cook University Hospital & Teesside University, Marton Road, Middlesbrough TS4 3BW, UK
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo 11, 80147 Naples, Italy
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Tamburrini S, Fiorini V, Lugarà M, Napodano G, Del Biondo D, Squame F, Sarti G, Quassone P, Coppola MG, Iannuzzi M, Di Stasio M, Shatalova O, Marano I, Cagini L. Nephrobronchial fistula a case report and review of the literature. Radiol Case Rep 2021; 16:3470-3477. [PMID: 34539942 PMCID: PMC8440951 DOI: 10.1016/j.radcr.2021.08.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/11/2021] [Indexed: 12/23/2022] Open
Abstract
Nephrobronchial fistula is an extremely rare complications of renal infections. We present a case of nephrobronchial fistula in a middle age immunocompetent woman who complained cough and weight loss, with underlying asymptomatic nephrolithiasis. She underwent a chest X-ray that showed left lower lobe infiltrate and abdominal ultrasound. Abdominal ultrasound showed a complicated pyonephrosis ; CT of chest-abdomen-pelvis with intravenous contrast was performed in order to stage and define the extension of the pathology. At CT, a suspected diagnosis of stage III xanthogranulomatous pyelonephritis complicated with pyonephrosis and a nephrobronchial fistula was formulated. A nephrostomy tube was placed, and the patient was treated with antibiotics. Follow up CT, performed after 15 days, showed the healing of the fistulous connection between the perinephric abscess and bronchi; the patient underwent nephrectomy with no airway complication during intubation. Histopathological diagnosis confirmed the presence on complicated xanthogranulomatous pyelonephritis.
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Affiliation(s)
| | - Valeria Fiorini
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Marina Lugarà
- Department of Internal Medicine, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Giorgio Napodano
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Dario Del Biondo
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Fiorenzo Squame
- Department of Nuclear Medicine, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Giuseppe Sarti
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Pasquale Quassone
- Department of Radiology, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | | | - Michele Iannuzzi
- Department of Anesthesiology and Intensive Care, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Mario Di Stasio
- Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Olena Shatalova
- Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Ines Marano
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Lucio Cagini
- Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
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