感染性休克时化脓性肝脓肿经膈肌扩张引起化脓性心包炎伴心脏填塞：病例报告
Transdiaphragmatic Extension of a Pyogenic Liver Abscess Causing Purulent Pericarditis With Cardiac Tamponade in Septic Shock: A Case Report.
摘要(中文译文)
化脓性心包炎在抗生素后时代是一种罕见且危及生命的疾病，占心包疾病的不到1%，并可进展为心脏压塞。由肝脓肿经膈肌播散是一种极为罕见的感染机制。本病例报告强调了在跨越多重解剖屏障的多微生物感染中，病原体不寻常的侵袭潜能。一名41岁男性，三年前有胃袖状切除术史，因难治性脓毒性休克和心脏压塞就诊。急诊超声引导下心包穿刺并置入心包引流管，引流出880 mL脓性液体。同期CT成像显示膈肌顶部有一巨大肝脓肿，与心包直接经膈肌相连续，突出了这一罕见的连续性播散解剖路径，并为化脓性心包感染提供了机制性解释。培养生长出 和 。治疗包括心包引流、影像引导下经皮引流肝脏集合以控制感染源、长期针对病原体的抗菌治疗，以及针对肺栓塞的治疗性抗凝。本病例报告描述了一种罕见且危及生命的组合，包括脓毒性休克、多发性化脓性肝脓肿、伴心脏压塞的化脓性心包炎以及肺栓塞。成功的管理需要协调的多学科诊疗，包括紧急心包引流以控制感染源并缓解血流动力学障碍、依据微生物学指导的长期针对病原体的抗菌治疗，以及在合并心脏压塞的情况下，为肺栓塞谨慎把握时机进行抗凝，同时平衡血栓形成与出血的竞争性风险。
Abstract
Purulent pericarditis is a rare, life-threatening condition in the post-antibiotic era, accounting for fewer than 1% of pericardial diseases, and may progress to cardiac tamponade. Transdiaphragmatic spread from a hepatic abscess is an exceedingly rare mechanism of infection. This case report highlights the unusual invasive potential of in a polymicrobial infection that crossed anatomical barriers. A 41-year-old man with a history of gastric sleeve surgery three years earlier presented with refractory septic shock and cardiac tamponade. Emergent ultrasound-guided pericardiocentesis with pericardial drain placement yielded 880 mL of purulent fluid. Concurrent CT imaging revealed a large hepatic abscess at the diaphragmatic dome with direct transdiaphragmatic continuity to the pericardium, highlighting a rare anatomical route of contiguous spread and providing a mechanistic explanation for the purulent pericardial infection. Cultures grew and Management included pericardial drainage, image-guided percutaneous drainage of the hepatic collections for source control, prolonged pathogen-directed antimicrobial therapy, and therapeutic anticoagulation for pulmonary embolism. This case report describes a rare, life-threatening combination of septic shock, multiple pyogenic liver abscesses, purulent pericarditis with cardiac tamponade, and pulmonary embolism. Successful management required coordinated multidisciplinary care, including urgent pericardial drainage for source control and relief of hemodynamic compromise, prolonged pathogen-directed antimicrobial therapy guided by microbiology, and carefully timed anticoagulation for pulmonary embolism while balancing the competing risks of thrombosis and bleeding in the setting of concurrent cardiac tamponade.
如何引用
AMA
Magdy Khames, Obaid Alzaabi, Saif Alkaabi, Abdalla Alnaqbi, Rady Ebead, Issam Marzouk, et al. Transdiaphragmatic Extension of a Pyogenic Liver Abscess Causing Purulent Pericarditis With Cardiac Tamponade in Septic Shock: A Case Report.. Cureus. 2026; doi:10.7759/cureus.106733.
APA
Magdy Khames, Obaid Alzaabi, Saif Alkaabi, Abdalla Alnaqbi, Rady Ebead, Issam Marzouk, et al (2026). Transdiaphragmatic Extension of a Pyogenic Liver Abscess Causing Purulent Pericarditis With Cardiac Tamponade in Septic Shock: A Case Report.. Cureus. https://doi.org/10.7759/cureus.106733
GB/T 7714
Magdy Khames, Obaid Alzaabi, Saif Alkaabi, Abdalla Alnaqbi, Rady Ebead, Issam Marzouk, et al. Transdiaphragmatic Extension of a Pyogenic Liver Abscess Causing Purulent Pericarditis With Cardiac Tamponade in Septic Shock: A Case Report.[J]. Cureus, 2026 doi:10.7759/cureus.106733.
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