Matches in SemOpenAlex for { <https://semopenalex.org/work/W4387268085> ?p ?o ?g. }
Showing items 1 to 59 of
59
with 100 items per page.
- W4387268085 endingPage "A1118" @default.
- W4387268085 startingPage "A1118" @default.
- W4387268085 abstract "SESSION TITLE: Infectious Connections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: Pyogenic liver abscess (PLA) is an uncommon complication of endoscopic retrograde cholangiopancreatography (ERCP) (1). Transdiaphragmatic rupture resulting in empyema has rarely been reported. Here we present a patient who developed acute hypoxemic respiratory failure and septic shock during treatment for PLA with imaging showing complete translocation of the fluid collection into the right pleural space. CASE PRESENTATION: An 89 year-old male with medical history of atrial fibrillation, coronary artery disease, ESRD, and recent choledocholithiasis presented to an outside hospital with fever and abdominal pain. Two months prior, he was diagnosed with choledocholithiasis, requiring serial ERCPs, with sphincterotomy, pancreatic stent placement, and eventual stone extraction. A CT of the abdomen/pelvis was obtained and revealed a 18 x 12 x 13 cm loculated collection with an air-fluid level within the liver, suspicious for a PLA. He was started on empiric piperacillin-tazobactam and transferred to our hospital for further treatment.Several hours after arrival, he acutely decompensated with development of shock and acute hypoxemic respiratory failure, requiring vasopressors, bilevel positive airway pressure, and transfer to the intensive care unit. A chest X-Ray showed near complete opacification of the right hemithorax with leftward shift of cardiomediastinal structures. A 14-french pigtail chest tube was inserted with initial output of 1.5 liters of frank pus. Follow-up CT demonstrated resolution of the large hepatic abscess and new moderate hydropneumothorax, consistent with empyema due to trans-diaphragmatic abscess rupture. The empyema resolved after 6 days of chest tube drainage with a single dose of intrapleural fibrinolytics. Fluid cultures grew Fusobacterium nucleatum. He was treated with IV antibiotics for 6 weeks. In the ensuing months he was lost to follow up at our institution and later noted to be deceased for an unknown reason. DISCUSSION: Spontaneous rupture of PLA occurs in roughly 3.8% of cases. Diameter greater than 6cm, history of cirrhosis, presence of gas in the collection, and other septic metastases are common risk factors for rupture (2). Contained ruptures can typically be managed by percutaneous drainage and antibiotics, as was done in this case, while ruptures resulting in peritonitis typically require urgent surgery (1, 2). The exact mechanism by which a PLA can result in ipsilateral empyema has not been fully elucidated. Rhythmic compressive forces by the diaphragm may weaken the fibrous abscess capsule leading to rupture. As occurs in hepatic hydrothorax, the negative pleural-peritoneal pressure gradient generated during spontaneous respiration then likely favors migration of the fluid into the pleural space across a small diaphragmatic defect (3). CONCLUSIONS: Transpleural rupture of a pyogenic liver abscess is a rare complication that can result in rapid clinical decompensation with a high mortality rate. This case highlights the importance of rapid identification and appropriate management when such an event occurs. REFERENCE #1: Kurland JE, Brann OS. Pyogenic and amebic liver abscesses. Current Gastroenterology Reports. 2004;6(4):273-279. doi:https://doi.org/10.1007/s11894-004-0078-2 REFERENCE #2: Jun CH, Yoon JH, Wi JW, et al. Risk factors and clinical outcomes for spontaneous rupture of pyogenic liver abscess. Journal of Digestive Diseases. 2015;16(1):31-36. doi:https://doi.org/10.1111/1751-2980.12209 REFERENCE #3: Rubinstein D, McInnes IE, Dudley FJ. Hepatic Hydrothorax in the Absence of Clinical Ascites: Diagnosis and Management. Gastroenterology. 1985;88(1):188-191. doi:https://doi.org/10.1016/s0016-5085(85)80154-2 DISCLOSURES: No relevant relationships by Gregory Eisinger No relevant relationships by Jonathan Henricks No relevant relationships by Patrick Sylvester" @default.
- W4387268085 created "2023-10-03" @default.
- W4387268085 creator A5001396869 @default.
- W4387268085 creator A5092988835 @default.
- W4387268085 creator A5070548867 @default.
- W4387268085 date "2023-10-01" @default.
- W4387268085 modified "2023-10-03" @default.
- W4387268085 title "ACUTE HYPOXEMIC RESPIRATORY FAILURE AND SEPTIC SHOCK AS A RESULT OF TRANSDIAPHRAGMATIC RUPTURE OF A PYOGENIC LIVER ABSCESS" @default.
- W4387268085 doi "https://doi.org/10.1016/j.chest.2023.07.810" @default.
- W4387268085 hasPublicationYear "2023" @default.
- W4387268085 type Work @default.
- W4387268085 citedByCount "0" @default.
- W4387268085 crossrefType "journal-article" @default.
- W4387268085 hasAuthorship W4387268085A5001396869 @default.
- W4387268085 hasAuthorship W4387268085A5070548867 @default.
- W4387268085 hasAuthorship W4387268085A5092988835 @default.
- W4387268085 hasBestOaLocation W43872680851 @default.
- W4387268085 hasConcept C126838900 @default.
- W4387268085 hasConcept C141071460 @default.
- W4387268085 hasConcept C2775967933 @default.
- W4387268085 hasConcept C2776888751 @default.
- W4387268085 hasConcept C2777063151 @default.
- W4387268085 hasConcept C2777628635 @default.
- W4387268085 hasConcept C2778329176 @default.
- W4387268085 hasConcept C2778384902 @default.
- W4387268085 hasConcept C2778444009 @default.
- W4387268085 hasConcept C2781300812 @default.
- W4387268085 hasConcept C71924100 @default.
- W4387268085 hasConceptScore W4387268085C126838900 @default.
- W4387268085 hasConceptScore W4387268085C141071460 @default.
- W4387268085 hasConceptScore W4387268085C2775967933 @default.
- W4387268085 hasConceptScore W4387268085C2776888751 @default.
- W4387268085 hasConceptScore W4387268085C2777063151 @default.
- W4387268085 hasConceptScore W4387268085C2777628635 @default.
- W4387268085 hasConceptScore W4387268085C2778329176 @default.
- W4387268085 hasConceptScore W4387268085C2778384902 @default.
- W4387268085 hasConceptScore W4387268085C2778444009 @default.
- W4387268085 hasConceptScore W4387268085C2781300812 @default.
- W4387268085 hasConceptScore W4387268085C71924100 @default.
- W4387268085 hasIssue "4" @default.
- W4387268085 hasLocation W43872680851 @default.
- W4387268085 hasOpenAccess W4387268085 @default.
- W4387268085 hasPrimaryLocation W43872680851 @default.
- W4387268085 hasRelatedWork W2003938723 @default.
- W4387268085 hasRelatedWork W2047967234 @default.
- W4387268085 hasRelatedWork W2118496982 @default.
- W4387268085 hasRelatedWork W2364998975 @default.
- W4387268085 hasRelatedWork W2369162477 @default.
- W4387268085 hasRelatedWork W2439875401 @default.
- W4387268085 hasRelatedWork W2461899158 @default.
- W4387268085 hasRelatedWork W4238867864 @default.
- W4387268085 hasRelatedWork W2420170407 @default.
- W4387268085 hasRelatedWork W2525756941 @default.
- W4387268085 hasVolume "164" @default.
- W4387268085 isParatext "false" @default.
- W4387268085 isRetracted "false" @default.
- W4387268085 workType "article" @default.