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Abdomen » Adult Renal
Renal and Perinephric Abscess
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Author(s) :
Danilo Sirigu, MD
 
Presentation A 29 year old female presents with fever, flank pain, leukocytosis and leukocyturia.
 
 
Caption: Right Kidney
Description: Initial transabdominal ultrasound of the right kidney reveals an enlarged kidney with a focal area of decreased echogenicity in the upper pole. The mass exhibits a hyperechoic periphery and a complex internal structure suggesting thick membranes and mixed fluid/solid elements. Through transmission is not significantly enhanced.
 
 
Caption: Right Kidney
Description: Scanning from a more oblique plane better demonstrates the complex renal mass with perinephric extension. Initial color Doppler shows no flow within the mass.
 
 
Caption: Right Kidney
Description: Scanning more medially again demonstrates the intrarenal mass. Color Doppler of the hilar region demonstrates the normal renal vasculature and absence of flow within the mass.
 
 
 
Caption: Right Kidney
Description: 
 
Differential Diagnosis Renal Lymphoma
Renal Carcinoma, Infected
Hemorrhagic Cyst
Infected Cyst
 
Final Diagnosis Renal and Perinephric Abscess
 
Discussion Renal and perinephric abscess are complications of urinary tract infection that usually occur in the
setting of acute pyelonephritis.  Pathologic changes in the acute pyelonephritis may be focal or diffuse.
Renal parenchyma in focal nephritis may be involved as a wedge – shaped or rounded area of
inflammation. The renal inflammation may lead to parenchymal necrosis with abscess formation.
Renal abscess tend to be solitary and may spontaneously decompress into the collecting system or
perinephric space.
Ultrasound is very important in the follow-up of renal abscess and for guidance of percutaneous drainage.
 
Case References
  1. Coelho, RF, Schneider-Monteiro, ED, Mesquita, JL, et al. Renal and perinephric abscesses: analysis of 65 consecutive cases. World J Surg 2007; 31:431.
  2. Shu, T, Green, JM, Orihuela, E. Renal and perirenal abscesses in patients with otherwise anatomically normal urinary tracts. J Urol 2004; 172:148.
  3. Buscarini, Campani; Abdominal Ultrasound; Idelson- Gnocchi
  4. Aaron Benson, MD, et al ; Renal Corticomedullary Abscess.   www.emedicine.com/med/topic2848.htm
 
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