Spinal epidural empyema extending from a pleural empyema: case description and anatomical overview

Torrealba‐Acosta, Gabriel; Hernández, Sylvia Josephy; Ulloa, Gabriel Castro; Rojas, Greivin Rodríguez

doi:10.1136/bcr-2017-222019

Cited by 4 publications

(4 citation statements)

References 12 publications

(8 reference statements)

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“…1 Notably, a case report described an epidural empyema extending from a pleural empyema. 2 This case also highlights the anatomical relationship between the epidural and pleural spaces.…”

Section: Descriptionmentioning

confidence: 75%

Untreated vertebral osteomyelitis extending to the mediastinum and lungs

et al. 2020

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“…1 Notably, a case report described an epidural empyema extending from a pleural empyema. 2 This case also highlights the anatomical relationship between the epidural and pleural spaces.…”

Section: Descriptionmentioning

confidence: 75%

Untreated vertebral osteomyelitis extending to the mediastinum and lungs

et al. 2020

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“…A focus should be placed on antimicrobials targeting MSSA, but empirical antimicrobial therapy covering MRSA and Gram-negative and anaerobic bacteria should also be considered. Cases have been reported in which chest wall pyomyositis developed into pleural empyema [ 17 , 18 ] or mediastinitis [ 19 ]. Surgical drainage should be performed promptly in cases with abscess formation, since extension to deeper organs leads to more severe symptoms and may be refractory to treatment.…”

Section: Discussionmentioning

confidence: 99%

Pectoralis Major Pyomyositis in a Patient With Diabetes: A Case Report and Literature Review

Tsunoda,

Nakamura,

Makiguchi

et al. 2024

Cureus

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Pyogenic myositis is a bacterial infection of skeletal muscle that is usually caused by Staphylococcus aureus and is common in tropical regions. Recently, this infection has also been reported in immunocompromised patients in temperate regions. The lower extremities and trunk are most affected, while involvement of the chest wall is rare. We report a case of pectoralis major pyomyositis caused by Morganella morganii in an 82-year-old Japanese man with type 2 diabetes mellitus who had undergone stenting for myocardial infarction. Four months prior to visiting our hospital, the patient became aware of pain in the right chest area, which gradually became swollen. One month before the visit, the pain and swelling had become more severe. At the visit, there was swelling in the right anterior thoracic region with a diameter of 10 cm and pain in the same region. On physical examination, his blood pressure was 133/64 mmHg, heart rate was 83 beats/min, and body temperature was 36.9℃. Initially, a sarcoma or other neoplastic lesion was suspected and a needle biopsy was performed. Pus was drained from the puncture site to collect wound culture. Needle biopsy of the lesion did not reveal any fungi or acid-fast bacteria, and a T-SPOT.TB test was negative. Computed tomography and magnetic resonance imaging suggested abscess formation under the pectoralis major muscle. A wound culture test detected Morganella morganii, and pectoralis major pyomyositis was diagnosed. Debridement was performed under general anesthesia. The necrotic pectoralis major muscle was excised, the abscess cavity was opened, and wound irrigation was performed. The postoperative course was good and the patient was discharged on the 16th postoperative day. There has been no recurrence in eight months postoperatively. Pectoralis major pyomyositis may not be relieved by antibiotics alone and may extend to deeper organs to form intrapleural abscesses. Therefore, prompt drainage should be performed to prevent serious complications in a case in which abscess formation is observed.

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“…In the adult literature, there have been few reports of pleural empyema extending to the epidural space leading to an epidural abscess [40][41][42][43][44][45] . It may be possible that in our case, an indolent undiagnosed bacterial pneumonia lead to the development of a pleural empyema that through invasion of the fascial planes separating the parietal pleura from the epidural space lead to the presenting features of epidural abscess, but it may also be possible that the epidural abscess developed via silent bacteremia and subsequent abscess rupture lead to the development of the contrast-enhanced fluid collection in the adjacent pleural cavity.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Group A streptococcal spinal epidural abscess presenting with recurrent symptoms of viral illness: An operative case report

Vig

Amarante

Hutchinson

et al. 2021

North American Spine Society Journal (NASSJ)

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Background: Spinal epidural abscess (SEA) in children is a rare condition with dangerous sequelae, and with only 22 other cases reported in the literature, treatment algorithms are poorly understood. Quick identification of the classic tried of sepsis, back pain and neurological deficit is critical. Source identification difficult and often cannot be identified. Reported pathogens include varicella-zoster virus, S. aureus, and S pyogenes. Case description:We report a case of spontaneous pediatric SEA in a 22-month old female without obvious neurologic deficit, who underwent a T10-11 decompressive laminotomy and evacuation of abscess and subsequent 3-week course of intravenous ceftriaxone for culture positive S. pyogenes Outcome: The patient showed marked improvement in symptoms after decompression. 5 weeks postoperatively after transitioning from intravenous ceftriaxone to oral ceftin, the patient redeveloped a deep space infection and was taken back for a repeat debridement. The cultures from this procedure were negative and the patient was discharged on oral clindamycin.Conclusions: Pediatric spontaneous SEA is a rare condition and early diagnosis and surgical intervention if indicated can prevent dangerous sequelae. Further studies into the surgical indications for decompression will aid in algorithmic decision making.

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Spinal epidural empyema extending from a pleural empyema: case description and anatomical overview

Cited by 4 publications

References 12 publications

Untreated vertebral osteomyelitis extending to the mediastinum and lungs

Untreated vertebral osteomyelitis extending to the mediastinum and lungs

Pectoralis Major Pyomyositis in a Patient With Diabetes: A Case Report and Literature Review

Pediatric Group A streptococcal spinal epidural abscess presenting with recurrent symptoms of viral illness: An operative case report

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