Subphrenic Abscess as a Complication of Hemodialysis Catheter-Related Infection
Subphrenic abscesses are localized collections of pus, usually underneath the right or left hemi-diaphragm.There is a accumulation of infected fluid between the diaphragm, the liver and the spleen
"We describe an unusual case of subphrenic abscess complicating a central venous catheter infection caused by Pseudomonas aeruginosa in a 59-year-old woman undergoing hemodialysis. The diagnosis was made through computed tomography, and Pseudomonas aeruginosa was isolated from the purulent drainage of the subphrenic abscess, the catheter tip and exit site, and the blood culture samples. A transesophageal echocardiography showed a large tubular thrombus in superior vena cava, extending to the right atrium, but no evidence of endocarditis or other metastatic infectious foci. Catheter removal, percutaneous abscess drainage, anticoagulation, and antibiotics resulted in a favourable outcome."
"Infection is a common complication of central venous catheters (CVC) used for vascular access in hemodialysis patients. Gram-positive bacteremia is the typical clinical presentation of CVC related infectious complications.Pseudomonas aeruginosa is a less frequent pathogen associated with catheter infection, accounting for 4–16% of isolates . Nevertheless, this pathogen should always be considered as one potential causative agent of CVC related infections, especially in immunocompromised hosts. Metastatic infectious foci are important determinants of the morbidity and mortality of CVC related infections. Endocarditis, septic embolism, and visceral abscesses are rare but serious complications whose mere suspicion demands careful clinical and radiological search.
We report a case of a subphrenic abscess and CVC related bloodstream infection with Pseudomonas aeruginosa in a 59-year-old woman on haemodialysis."
Reference: Caravaca, F., Burguera, V., Fernández-Lucas, M., Teruel, J.L. and Quereda, C. (2014) Subphrenic abscess as a complication of hemodialysis catheter-related infection. Case Reports in Nephrology. July 10th. [epub ahead of print].