Images in Clinical Medicine
Xanthogranulomatous Pyelonephritis
N Engl J Med 2000; 342:1572May 25, 2000
- Article
Figure 1 An 86-year-old woman with a several-year history of recurrent urinary tract infections presented with vague abdominal symptoms. Physical examination disclosed right-flank tenderness. She had an Escherichia coli urinary tract infection. A contrast-enhanced computed tomographic (CT) scan, obtained because the findings on ultrasonography and radiography were inconclusive, showed typical findings of xanthogranulomatous pyelonephritis in the right kidney (Panel A). This chronic bacterial infection of the kidneys is characterized by the destruction of renal parenchyma and the presence of granulomas, abscesses, and cellular infiltrates of lipid-laden macrophages (foam cells). Multiple masses (M) replaced the renal parenchyma and extended into the perinephric space (PN). The walls (W) of these masses were enhanced, and some masses contained calculi (C). The patient was sent home while taking ofloxacin. Six months later, she was examined after bumping into the edge of a table and was found to have a large mass in the right flank. A CT scan showed perforation of the right renal capsule with extrusion of the contents of a mass into the retroperitoneal and subcutaneous space (Panel B). A culture of pus drained from the mass was positive for Streptococcus constellatus. A right nephrectomy was subsequently performed, and the patient was well four years after surgery.
Bruno Van Vlem, M.D.
Jean-Marie Billiouw, M.D.
Onze-Lieve-Vrouw Hospital, B-9300 Aalst, Belgium- Citing Articles (1)
Citing Articles
1
Sujatha Siddappa, Kowsalya Ramprasad, Mythri Kuthagale MuddeGowda. (2011) Xanthogranulomatous Pyelonephritis: A Retrospective Review of 16 Cases. Korean Journal of Urology 52:6, 421
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