Empyema caused by transdiaphragmatic extension of pyogenic liver abscess

Kim, Doh Hyung

doi:10.1002/ccr3.1950

Cited by 8 publications

(8 citation statements)

References 2 publications

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“…Potential contribution to development of empyema by transdiaphragmatic translocation from intraabdominal infection cannot be excluded (16,17). However, in all of the ten cases described in this series no relevant effusion nor beginning empyema was visible prior to drain placement.…”

Section: Discussionmentioning

confidence: 73%

Empyema after image-guided percutaneous intercostal drainage of subdiaphragmatic collection: a case series

Zwicky¹,

Rouiller²,

Candinas³

et al. 2022

J Thorac Dis

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Background: Treatment of subdiaphragmatic collection by intercostal image-guided drain placement is associated with a risk of pleural complications including potentially life-threatening pleural empyema.Descriptions of patient characteristics and clinical course of postinterventional pleural empyema are lacking.We aim to present characteristics, clinical course and outcomes of patients with empyema after intercostal approach of drain placement.Methods: Data was collected as a retrospective single center case series and included adult patients with decortication for treatment of pleural empyema after image-guided percutaneous intercostal drainage of a subdiaphragmatic collection between 01.01.2009 and 31.01.2021. Results:We identified ten patients, nine male and one female, all suffering from subdiaphragmatic collection treated with intercostal drain. All patients developed pleural empyema after drain placement and received surgical decortication. Similarities between patients were drain placement under computed tomography (CT)-guidance (eight of ten patients), lateral position of the drain (seven of ten patients), drain insertion in the eighth intercostal space (ICS) (six of ten patients) and existing comorbidities as malnutrition (six of ten patients), diabetes (four of ten patients) and cancer (three of ten patients). The majority of patients had a prolonged length of hospital stay (LOS) with an average duration of 40 days. Nearly half of the patients needed intensive care unit (ICU) treatment and one patient died postoperatively from respiratory exhaustion.Conclusions: In this series, empyema after intercostal drainage was associated with prolonged LOS and was potentially life-threatening. The most commonly shared features in our cohort were the high prevalence of comorbidities, drain insertion above ninth ICS as well as lateral position of the drain. These factors should be addressed in prospective studies to evaluate potential correlation with postinterventional empyema. For optimal management of patients with subdiaphragmatic collection treated by intercostal drainage, awareness of potential associated complications is crucial.

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Section: Discussionmentioning

confidence: 73%

Empyema after image-guided percutaneous intercostal drainage of subdiaphragmatic collection: a case series

Zwicky¹,

Rouiller²,

Candinas³

et al. 2022

J Thorac Dis

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“…Parapneumonic pleural effusion constitutes about 60% of all causations, followed by iatrogenic and traumatic cases [ 25 ]. Transdiaphragmatic extension of hepatic abscess is an extremely rare causative factor [ 20 ]. The evolving pattern of empyema has been represented in 3 distinctive stages to facilitate the decision regarding extent of intervention.…”

Section: Discussionmentioning

confidence: 99%

Pleural Empyema as a Complication of Pyogenic Liver Abscess: Can the Minimum Achieve the Optimal? A Comparison of 3 Approaches

et al. 2021

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Case series Patients: Male, 29-year-old • Male, 42-year-old • Male, 26-year-old Final Diagnosis: Empyema Symptoms: Abdominal pain • dyspnea Medication: — Clinical Procedure: — Specialty: Surgery Objective: Rare coexistence of disease or pathology Background: Pyogenic liver abscess is an uncommon entity that is potentially lethal. Pleural empyema and mediastinal collection are 2 rare complications of hepatic abscess that negatively impact the prognosis. Case Reports: Herein, we report 3 cases of pyogenic liver abscesses complicated by pleural empyema, each approached differently, along with a succinct review of the literature. Case 1: A 29-year-old man diagnosed with Crohn’s disease presented with Crohn’s disease-associated hepatic abscess complicated by pleural empyema and concurrent mediastinal collection. The patient demonstrated significant improvement after administration of intrapleural fibrinolytic therapy. Case 2: A 42-year-old man with unremarkable past medical history presented with abdominal pain and dyspnea. Upon investigation, he was found to have massive pleural empyema secondary to liver abscess. In contrast to case 1, case 2 required pleural debridement via video-assisted thoracoscopic surgery followed by formal decortication through a posterolateral thoracotomy. Thereafter, a dramatic clinical improvement was observed. Case 3: A 26-year-old man with history of brucellosis 6 months before was transferred to our facility as a case of pleural empyema secondary to transdiaphragmatic extension of liver abscess. Unlike case 1 and 2, this patient was managed by drainage of hepatic and pleural collections under radiological guidance only, without the need for intrapleural fibrinolytic therapy or surgical intervention. Conclusions: The current paper sheds light on one of the uncommon complications of hepatic abscess and contributes to this scant literature by summarizing pertinent publications. Adequate drainage remains the cornerstone of any pus collection management despite the complexity of some encountered cases.

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“…In patients with concurrent empyema and hepatic abscess, hepatic abscess drainage is usually required after drainage of the pleura [ 1 , 2 , 3 ]. Remarkably, our patient had significant improvement in the hepatic collection after drainage of the empyema.…”

Section: Discussionmentioning

confidence: 99%

“…Anginosus group streptococci are part of normal human flora and are widely known for disseminated pyogenic infection. Concurrent empyema and liver abscess have rarely been reported in the literature [ 1 ]. Typically, drainage of both the empyema and the liver abscess is required for complete resolution of the hepatic abscess [ 1 , 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Concurrent empyema and liver abscess have rarely been reported in the literature [ 1 ]. Typically, drainage of both the empyema and the liver abscess is required for complete resolution of the hepatic abscess [ 1 , 2 , 3 ]. We present a rare case of a hepatic abscess that rapidly resolved after drainage of the pleural Streptococcus anginosus empyema in an elderly male patient.…”

Section: Introductionmentioning

confidence: 99%

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A Rare Case of Hepatic Abscess That Resolved after Drainage of Pleural Empyema

et al. 2021

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Empyema has rarely been associated with hepatic abscess. In patients with concurrent empyema and hepatic abscess, hepatic abscess drainage is usually required after drainage of the pleura. We present a rare case of a 91-year-old Caucasian man who presented with a 2-week history of productive cough, fever, shortness of breath, and generalized malaise. The patient was found to have concurrent streptococci empyema and hepatic abscess, and, interestingly, the hepatic abscess resolved after the drainage of the empyema and initiation of antibiotics.

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Empyema caused by transdiaphragmatic extension of pyogenic liver abscess

Cited by 8 publications

References 2 publications

Empyema after image-guided percutaneous intercostal drainage of subdiaphragmatic collection: a case series

Empyema after image-guided percutaneous intercostal drainage of subdiaphragmatic collection: a case series

Pleural Empyema as a Complication of Pyogenic Liver Abscess: Can the Minimum Achieve the Optimal? A Comparison of 3 Approaches

A Rare Case of Hepatic Abscess That Resolved after Drainage of Pleural Empyema

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