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.
- What does the scan show?
- What is the initial management?
- 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:
- 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
- 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
- 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
