経胸腔穿刺となった肝膿瘍に対する経皮経肝ドレナージによる急性膿胸

Empyema Secondary to Percutaneous Liver Drainage via Thoracic Cavity for Hepatic Abscess

肝膿瘍に対する経皮経肝ドレナージが経胸腔穿刺となると，まれに肝臓の膿瘍腔と胸腔が交通して膿胸を合併する1，2）．われわれは経皮経肝ドレーンの経胸腔穿刺によって右膿胸を発症し，胸腔鏡下膿胸腔掻爬術により治療が奏功した1例を経験したため報告する．

Percutaneous liver drainage is associated with few complications. We report a case of empyema secondary to passage of a drain through the chest cavity in a patient treated with percutaneous liver drainage for hepatic abscess. A 72-year-old man was diagnosed with a liver abscess and underwent percutaneous liver drainage via the 7th intercostal space. He developed fever 7 days after the drainage procedure and was diagnosed with empyema on chest computed tomography and underwent video-assisted thoracoscopic curettage. Intraoperatively, we observed the liver drainage tube penetrated the thoracic cavity and the diaphragm, and he was diagnosed with iatrogenic empyema. The patient’s postoperative course was uneventful, and the chest drain was removed on the 3rd postoperative day. Percutaneous liver drainage is associated with the risk of penetration of the thoracic cavity and the diaphragm.