Presentation
Female patient with a history of Cacchi-Ricci disease (medullary sponge kidney) with known lithiasis on the right kidney who presented fever and right flank pain with no response to oral antibiotics. Blood tests showed leukocytosis and elevated c-reactive protein. A CT scan was performed to rule out complicated pyelonephritis.
Patient Data
ER CT scan in portal venous phase shows a hypodense fluid collection in the renal parenchyma adjacent to the renal sinus with a peripheral enhancing rim, containing microlithiasis.
Excretory phase shows signs of bilateral renal tubular ectasia with an apparently normal right urinary tract. The fluid collection did not show contrast accumulation in excretory phase.
The findings of the CT scan suggested an abscessification in the right kidney, possibly secondary to an infected calyceal diverticulum. A percutaneous nephrostomy was placed obtaining purulent material.
After a few days of intravenous antibiotics, about 1000 cc of clear urine were obtained daily from the nephrostomy. An antegrade pyelography was performed and it confirmed the communication of the previously infected cavity with the rest of the right urinary tract, consistent with a calyceal diverticulum.
Case Discussion
Calyceal diverticula are uncommon findings in abdominal radiology. However, they need to be recognized because sometimes they can be occupied by urolithiasis and, less frequently, be complicated with infection or abscessification, as in this case.
Our patient was asymptomatic after 1 week of IV antibiotic treatment, the urine was clear and the blood tests were back to normal.
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