DOI: https://doi.org/10.36347/sjmcr.2025.v13i07.041

Pages: 1684-1686

Pyelopleural fistulas are an exceptionally rare clinical entity, characterized by an abnormal communication between the upper urinary tract and the pleural cavity, most often secondary to chronic pyonephrosis. We report the case of a 48-year-old man hospitalized for a persistent left-sided pyothorax that did not resolve despite thoracic drainage performed 12 days earlier. The clinical presentation included severe sepsis, gross pyuria, and acute renal failure. Contrast-enhanced thoraco-abdominopelvic CT imaging revealed a left-sided pyonephrosis with a large staghorn calculus and a perirenal collection extending through the diaphragm into the pleural cavity, consistent with a pyelopleural fistula. Management included targeted antibiotic therapy, continued pleural drainage, and percutaneous nephrostomy. This case highlights the importance of considering a urological etiology in unexplained, persistent pyothorax.