Disorders of the Pleura |

Thoracic Empyema From Psoas Abscess FREE TO VIEW

Ching Yee Tan, MMed; Jeffrey Ng, MMed
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Respiratory and Critical Care Medicine, National University Health System, Singapore, Singapore

Chest. 2014;146(4_MeetingAbstracts):474A. doi:10.1378/chest.1988346
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SESSION TITLE: Pleural Disease Global Case Reports

SESSION TYPE: Global Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: We describe a 40 year old male diabetic who had a left pleural empyema originating from a pre-existing psoas abscess.

CASE PRESENTATION: A 40 year old diabetic male developed methicillin sensitive staphylococcus aureus bacteraemia from lumbar discitis and left psoas abscess. During admission, he was treated with intravenous antibiotics and insulin for diabetes. He subsequently defaulted treatment. Eight months later, he presented with non productive cough and dyspnea for duration of 2 weeks. No back pain was reported. He was tachypneic and had physical findings of left sided pleural effusion. Chest x-ray showed opacification of left hemi-thorax. Pleural aspirate yielded greenish frank pus. A small bore chest drain was inserted. In view of the history of discitis and left psoas abscess, a computed tomography of the abdomen (Image 1) was which showed a multi-loculated iliopsoas abscess extending along paravertebral space into the left pleural cavity. Surgical debridement and drainage of the psoas abscess was performed. Cardiothoracic consult obtained was for continued tube drainage of pleural empyema and not for surgical intervention as the primary pathology was the iliopsoas abscess. Subsequent, pleural fluid culture grew methicillin sensitive staphylococcus aureus. He was treated with intravenous cloxacillin for extended duration. Treatment of diabetes mellitus, with HbA1c 13.7%, was optimized with subcutaneous insulin.

DISCUSSION: Psoas abscess tracking up into the pleural space and causing a pleural empyema is uncommonly reported. Cases of psoas abscess associated with empyema1,2 or pleural effusion3 were reported. The patient we described had radiological evidence of tracking of psoas abscess into pleural space. He also responded to surgical drainage of his psoas abscess, which is his primary pathology, and did not require any thoracic surgery. In the cases described, significant number of patients who developed psoas abscess associated with empyema were diabetic. Management of these patients required multi disciplinary collaboration between medical and surgical team for optimal outcomes of these cases.

CONCLUSIONS: We describe a case of pleural empyema originating from pre-exisiting psoas abscess in a diabetic male patient who required multi disciplinary medical and surgical approach to optimal management.

Reference #1: Psoas abscess : analysis of 27 cases. Lin MF et al. J Microbiology Immunol Infect. 1999 Dec;32(4):261-8.

Reference #2: Empyema and psoas abscess in a previously undiagnosed diabetic patient. Liu L et al. N Z Med J. 2013 Feb 15;126(1369):79-82.

Reference #3: Pleural effusion associated with a psoas abscess dissecting through the posterior abdominal wall. Adil Zamani et al. Turkiye Klinikleri Journal of Medical Sciences 12/1998; 18(6):402-405

DISCLOSURE: The following authors have nothing to disclose: Ching Yee Tan, Jeffrey Ng

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