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Obstructive pyelonephritis

Case contributed by Bruno Di Muzio
Diagnosis certain

Presentation

Septic shock and renal failure.

Patient Data

Age: 70 years

US Abdomen and pelvis

ultrasound

Right kidney has normal appearances. Left kidney is enlarged and severely hydronephrotic. 

CT Abdomen and pelvis

ct

Noncontrast CT demonstrating left-sided renal lobulated fluid attenuation masses are most likely abscesses in this context. There may also be a high-grade pelviureteric junction obstruction with an infected collecting system. 

Nephrostomy

dsa

Ultrasound-guided puncture of lower pole calyx. Frank purulent material obtained from access sheath and sent for MCS. An 8.5Fr nephrostomy tube was secured in the renal pelvis. No complication encountered.

Case Discussion

This case illustrates a complicated obstructive pyelonephritis, which usually requires prompt treatment aiming to save the kidney viability. Left kidney is showing severe hydronephrosis and cortical thinning may represent a chronic long standing pelvic-ureteric junction obstruction.

Microbiology of the drained collection: 

Fluid Description : Nephrostomy drain fluid

MICROSCOPY GRAM STAIN

  • Leukocytes +++
  • Gram positive cocci +++

CULTURE Enterococcus faecalis +++

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