Renal fungal balls

Case contributed by Paresh K Desai
Diagnosis almost certain

Presentation

Three days of anuria.

Patient Data

Age: 1 year
Gender: Male
ultrasound

Heteroechoic lesions (predominantly hypoechoic with echogenic areas within) filling the dilated pelvicalyceal system. A possible diagnosis is of fungal balls obstructing the pelvicalyceal systems bilaterally.

Case Discussion

Given the age of the patient and ultrasound appearance of obstructing primarily hypoechoic masses bilaterally, a possible diagnosis of bilateral fungal balls was proposed. However there is a broad differential diagnosis, including:

  1. non-fungal pyogenic or inflammatory debris
  2. blood clot
  3. tumor (e.g. transitional cell carcinoma)
  4. sloughed papilla

In this patient, the urine culture revealed a growth of Candida spp. which strongly supports a diagnosis of fungal balls. This possibility has to be considered in lesions filling the pelvicalyceal system in infants and immunosuppressed patients.

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