Obstructive pyelonephritis

Case contributed by Dr Bruno Di Muzio

Presentation

Septic shock and renal failure.

Patient Data

Age: 68-year-old
Ultrasound

US Abdomen and pelvis

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

CT

CT Abdomen and pelvis

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. 

DSA (angiography)

Nephrostomy

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

  • Leucocytes +++
  • Gram positive cocci +++

CULTURE Enterococcus faecalis +++

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Case information

rID: 46411
Case created: 4th Jul 2016
Last edited: 6th Jul 2016
System: Urogenital
Tag: rmh
Inclusion in quiz mode: Included

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