1981 Volume 72 Issue 6 Pages 758-766
Case 1: A 57-year-old female, complaining of fever and pain in the left flank, was admitted. A diagnosis of left pyelonephritis was made, but the patient gradually developed a bulging in the left flank. A KUB film revealed a soft-tissue mass inferior to the left kidney. An excretory pyelogram showed that the middle and lower cayces of the left kidney were not sharply outlined, and that the urinary bladder was displaced to the right. X-rays of the chest revealed a collection of fluid at the left base. A diagnosis of left retroperitoneal space abscess was made, and the abscess was drained. Cultures of the pus showed do presence of bacteria.
Case 2: A 48-year-old female, complaining of pain in the left flank and a high fever, was admitted. The patient had previously had an appendectomy fifteen years before. A diagnosis of left pyelonephritis and left ureteral stone was made, but she suddenly developed severe dyspnea. X-rays of the chest showed effusion. Later, physical examination revealed a tender mass in the right lower abdomen. An excretory pyelogram revealed a large homogeneous density, which corresponded with the palpable mass, and the upward displacement of the right kidney. First the right and then the left retroperitoneal abscesses were drained. Cultures of the pus revealed no presence of bacteria. In both cases 1 and 2, left pyelonephritis developed into left retroperitoneal abscess, and the left abscess in case 2 was thought to have spread further into the right retroperitoneal space through the pelvic space. The hydrothorax was thought to be secondary to retroperitoneal space abscess, because it disappeared simply by drainage of the abscess.
The records of 62 cases of retroperitoneal abscess during the last 20 years reported in Japan were reviewed, and the causes, spread of infection, and development of hydrothorax in retroperitoneal abscess were discussed.
