Transdiaphragmatic nephropleural fistula: A rare cause of empyema thoracic managed with single-stage surgical approach

Abstract

Empyema thoracic arising from a retroperitoneal source via a transdiaphragmatic nephropleural fistula is among its exceptionally rare causes. This report describes successful management with single-stage combined thoracic and urological surgery. A young female with long-standing nephrolithiasis and recent percutaneous nephrolithotomy, presented with respiratory distress. Initial management included emergent tube thoracostomy for a gross right pyopneumothorax confirmed by computed tomographic (CT) scan of chest. Escherichia coli was cultured from pleural fluid and urine samples. Further contrast enhanced CT findings confirmed Empyema thoracic, transdiaphragmatic nephropleural fistula and lower pole renal cortical defects with emphysematous pyelonephritis. Single-stage right thoracotomy and decortication, repair of the diaphragmatic rent and right nephrectomy achieved excellent outcomes. This case highlights transdiaphragmatic nephropleural fistula as a rare cause of empyema thoracic.