Transphrenic spread of disease has received scant attention in the literature. Beye1 reported ten cases of transphrenic spread of infection. In nine cases, the extension was from a secondary subphrenic abscess to the thorax, and in seven of these there was a spontaneous or operative defect in the diaphragm. In the tenth case, the spread was from the thorax to the abdomen. In Beye's opinion, the primary lesion began in the appendix four times, in peptic ulcers four times, as a perinephric abscess once, and as acute empyema once. He concluded that extension upward from a subphrenic abscess is not uncommon, but that extension downward from empyema is infrequent. This extension of infection through the diaphragm is sufficiently common to be mentioned in a number of standard textbooks as a complication of empyema and subphrenic abscess. Pratt,2 quoting Robson and Moynihan, mentioned the finding of fat necroses in
GROSECLOSE ES, SWINEFORD O. TRANSPHRENIC SPREAD OF DISEASE: WITH REPORTS OF SIX CASES. Arch Surg. 1932;24(4):681–686. doi:10.1001/archsurg.1932.01160160153010
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