Case Study - May 2009

This is an abdominal CT scan of an 82-year-old woman with a 6-month history of left flank pain and recurrent urinary infections who was pyrexial on admission. There was a palpable, slightly tender mass in the left hypochondrium.

  1. What does the scan show?
  2. What is the initial management?
  3. What further measures are necessary?

Reveal Answer

Open answerThere is no fixed answer to this question, however your response should be similar to the one below:

  1. The CT (performed after IV administration of contrast medium) shows no function in the left kidney which is replaced by debris/pus and is surrounded by a large perinephric abscess containing gas. There are several calculi in the left renal pelvis obstructing the kidney
  2. Initial management is drainage of the abscess which was performed percutaneously under ultrasound control. 250ml of frank pus was obtained with immediate relief of her pyrexia
  3. DMSA scintigraphy showed no function in the left kidney and a simple nephrectomy was performed

Further comments
Histology showed typical appearances of xanthgogranulomatous pyelonephritis due to stone obstruction and chronic infection

illustrative image for answer to question $n

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