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

Abstract

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.

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

“…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.…”

Streptococcus intermedius Bacteremia and Pyogenic Liver Abscess in a Patient With No Risk Factors

“…Diaphragmatic extension of PLA has been documented; however, studies and case reports lack on the management of pleural empyema secondary to PLA extension across the diaphragm. The presence of pleural empyema secondary to PLA carries a negative impact on prognosis for patients [12] and it played a major part in the readmission of our patient. Our patient's pleural empyema was managed by placement of a 12 French pigtail chest tube by interventional radiology, and IV ceftriaxone via PICC line course was extended.…”

“…Multiple complications can arise from PLAs, with around 40% of patients experiencing a complication, including sepsis/septic shock, pleural effusion, abscess rupture, venous thrombosis, thoracic empyema, and mediastinitis [3,9,11]. The least common is thoracic empyema or mediastinitis, secondary to a communicating fistula [12]. Our patient's case depicts the rare complication of empyema secondary to a PLA, likely due to communicating fistula between abscess and pleural cavity.…”

Pasteurella multocidabacteraemia with liver abscess

“…This was consistent with the management of Goussard et al 11 . P. multocida resistance strains are increasing isoalted in animals, which might change the spectrum of antimicrobial choices for human cases in future 17 18…”