| A patient with chronic vulvo-vaginitis due to trichomonas vaginalis, and obstructive uropathy associated with renal calculi, developed a perinephric abscess following trauma incurred in a motorcycle accident. T. vaginalis was seen on smear and cultured from the purulent drainage from the perinephric abscess. Although T. vaginalis is commonly pathogenic only to the lower genito-urinary system, the upper urinary tract may very rarely be involved by ascending infection. If this protozoan spreads to extraluminal sites the inflammatory potential is marked, as has been found in animals with experimental infection. Examination of a fresh smear of pus may be critically important in the diagnosis of closed-space infections of unknown etiology. ( info) |
2/15. Bilateral xanthogranulomatous perinephritis without renal parenchymal involvement. A case of isolated bilateral xanthogranulomatous perinephritis, which presented as a symmetrical irregular perirenal rim of soft tissue, is reported. Differential diagnosis and image features on ultrasound, computed tomography, and magnetic resonance are discussed. ( info) |
3/15. How should an infected perinephric haematoma be drained in a tetraplegic patient with baclofen pump implanted in the abdominal wall? - A case report. BACKGROUND: We present a case to illustrate controversies in percutaneous drainage of infected, perinephric haematoma in a tetraplegic patient, who had implantation of baclofen pump in anterior abdominal wall on the same side as perinephric haematoma. CASE PRESENTATION: A 56-year-old male with C-4 tetraplegia had undergone implantation of programmable pump in the anterior abdominal wall for intrathecal infusion of baclofen to control spasticity. He developed perinephric haematoma while he was taking warfarin as prophylactic for deep vein thrombosis. Perinephric haematoma became infected with a resistant strain of pseudomonas aeruginosa, and required percutaneous drainage. Positioning this patient on his abdomen without anaesthesia, for insertion of a catheter from behind, was not a realistic option. Administration of general anaesthesia in this patient in the radiology department would have been hazardous. RESULTS AND CONCLUSION: Percutaneous drainage was carried out by anterior approach under propofol sedation. The site of entry of percutaneous catheter was close to cephalic end of baclofen pump. By carrying out drainage from anterior approach, and by keeping this catheter for ten weeks, we took a risk of causing infection of the baclofen pump site, and baclofen pump with a resistant strain of pseudomonas aeruginosa. The alternative method would have been to anaesthetise the patient and position him prone for percutaneous drainage of perinephric collection from behind. This would have ensured that the drainage track was far away from the baclofen pump with minimal risk of infection of baclofen pump, but at the cost of incurring respiratory complications in a tetraplegic subject. ( info) |
4/15. Perinephric abscess from insulin syringe reuse. Perinephric abscess is a rare and often missed diagnosis. diabetes mellitus and injection drug use are often considered among the predisposing factors for perinephric abscess. Diabetic patients are taught to discard insulin syringes after a single use. Described here is a patient who developed perinephric abscess from contaminated insulin syringes. physicians are often unaware of the high prevalence of disposable insulin syringe reuse in the community. ( info) |
5/15. Xanthogranulomatous pyelonephritis, perinephric type--a case report. A 46 year-old woman with perinephric type of xanthogranulomatous pyelonephritis is described. She had a fever and pain with a palpable mass in her right flank. The blood analysis revealed anemia, leucocytosis, gamma-globulinemia, but no hyperlipidemia. The urine analysis showed nothing abnormal, but enterobacter was present in the urine. An intravenous pyelogram demonstrated a right non-functioning kidney. The diagnosis of a perinephric abscess was made from the x-ray and ultrasonogram, and a right nephrectomy was performed. The resected kidney had a tumor-like lump covered with Gerota's fascia at the postero-lateral side of the kidney. The cut surface of the kidney revealed an area of hemorrhage, blood clotting, abscess and a brownish yellow area in the perinephric fat tissue. The calyx and pelvis were normal. Histologically, the brownish yellow area was a granuloma with foam cell infiltration. The foam cells contained lipids. The renal parenchyma showed a non-specific chronic pyelonephritis. ( info) |
6/15. Splenic abscess arising by direct extension from a perinephric abscess. A case of a perinephric abscess invading the spleen in a 25-year-old woman with bladder exstrophy is reported. Treatment utilized both percutaneous drainage and open surgery. Perinephric abscesses have not been previously reported to extend into the spleen. ( info) |
7/15. Bilateral perinephric abscesses: a complication of endoscopic injection sclerotherapy. Ten years after right hepatic lobectomy for primary hepatocellular cancer, a 45-yr-old black woman presented with bleeding esophageal varices. After five endoscopic injection sclerotherapy procedures using sodium morrhuate, she developed fever and elevated white blood count. Reendoscopy, chest x-ray, and upper gastrointestinal contrast x-rays showed no local complication. urine analysis was normal, but CT scans, renal sonograms, and white blood cell radionuclide scan demonstrated bilateral perinephric abscesses. Percutaneous abscess drainage grew streptococcus pneumoniae, normally found in the nasopharyngeal flora, which was probably a result of hematogenous spread. The perinephric abscesses were successfully treated with percutaneous drainage and antibiotics. Renal infection should be considered as a possible locus of distant blood-borne infection in patients who develop fever after endoscopic injection sclerotherapy. ( info) |
8/15. Perisplenitis and perinephritis in the Curtis-Fitz-Hugh syndrome. Four cases of the Curtis-Fitz-Hugh syndrome diagnosed laparoscopically and with microbiological or serological evidence of chlamydial pelvic infection are reviewed. The case histories emphasize the part played by renal angle and left upper quadrant symptoms. In one patient the surface of the spleen was affected by the same classical inflammation normally seen on the surface of the liver. In 3 patients bilateral or left-sided renal angle pain and tenderness constituted the presenting features, or a major manifestation, and in all patients renal tract investigations were entirely normal. The patient with laparoscopic perisplenitis also had perihepatitis and pelvic inflammation, the latter being florid in all cases. Perisplenitis and perinephritis are proposed as possible additional manifestations of this syndrome. ( info) |
9/15. Xanthogranulomatous perinephritis: unusual cause of renal vein and vena caval thrombosis. Xanthogranulomatous pyelonephritis is an uncommon form of chronic renal infection which can be confused clinically, radiographically, and pathologically with renal carcinoma. Occasionally, xanthogranulomatous changes are more prominent in perinephric tissue than in the renal parenchyma itself. We present a case of locally invasive xanthogranulomatous perinephritis associated with thrombosis of the renal vein and inferior vena cava. With this constellation of findings, infections as well as malignant etiologies should be considered in the differential diagnosis. ( info) |
10/15. Perinephric abscess in patients with polycystic kidney disease undergoing chronic hemodialysis. 5 patients with polycystic kidney disease undergoing chronic hemodialysis who developed perinephric abscesses are described. gallium-67 scintigraphy was helpful in making a diagnosis in 2 of these patients. All 5 patients initially presented with urinary tract infections. Perinephric abscess became evident over a variable period of time (2--28 days) following completion of antibiotic therapy for their urinary tract infection. gallium-67 scintigraphy appears useful in detecting this complication, and nephrectomy should be considered once the diagnosis is confirmed. ( info) |