What question did this study set out to answer?

To illustrate a rare case where a pleural infection was the initial presentation of a retroperitoneal abscess.

March 19, 2026Open Access

Pleural Infection as the First Presentation of a Large Retroperitoneal Abscess

Key Points

To illustrate a rare case where a pleural infection was the initial presentation of a retroperitoneal abscess.
Case report of an 81-year-old man
Utilized imaging to identify retroperitoneal fluid collection
Performed drainage and administered antibiotics and tPA/DNase therapy
Imaging showed large gas-containing fluid collection and loculated pleural effusion
Both fluid collections tested positive for Escherichia coli
Patient improved significantly after treatment including drainage and antibiotics

Abstract

ABSTRACT Empyema originating from a retroperitoneal source is rare due to the anatomical separation between the retroperitoneal and pleural spaces. We report the case of an 81‐year‐old man who presented with pleuritic chest pain following empirical antibiotic treatment for a urinary tract infection. Imaging revealed a large retroperitoneal gas‐containing fluid collection and a left‐sided loculated pleural effusion with a small pneumothorax. Pleural and retroperitoneal collection fluid both grew Escherichia coli suggestive of trans‐diaphragmatic spread. A large hiatal hernia, structural defects of the hemidiaphragm and a Bochdalek hernia may also have been contributing factors. The patient improved with systemic antibiotics, percutaneous drainage of both collections and intrapleural administration of low dose tPA/DNase therapy. This case underscores the importance of considering extra‐thoracic (especially abdominal) sources, especially in patients with structural diaphragmatic abnormalities.

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