Perinephric abscess pointing into the posterior chest wall
Known chronic right ureteric obstruction by large upper ureteric calculus. Now severe right flank pain, fever and palpable loin mass.
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Grossly hydronephrotic right kidney due to a large ureteric calculus (arrow) with rupture of an upper pole calyx (arrow) producing a posterior peri/para-nephric collection that has perforated through the chest wall via the 11 - 12th rib interspace (arrow) entering the lateral erector spinae muscles.
In the past it was not unusual for untreated, chronically obstructed/infected kidneys (pyonephrosis) to present as a loin mass/abscess. It is now uncommon due to effective ureteric drainage with stents and liberal antibiotic use. Occasionally it is now seen in individuals with poor access to medical care. Treatment requires vigorous drainage of the abscess(es) and relief of ureteric obstruction.