Subcapsular renal collection - causing a Page kidney

Case contributed by Dr Ian Bickle

Presentation

39 year-old diabetic. Septic. Cause unidentified.

Patient Data

Age: 39
Gender: Male

Large BMI. Uncooperative patient. Ultrasound technically challenging. CT undertaken.

Multiple focal low attenuation areas in the right kidney, suggestive of a pyelonephritis and a subcapsular collection, with maximum depth of 3.5cm.

Poor venous access, resulted in a sub-optimal contrast enhanced scan - diagnostic discussion if subcapsular or perinephric collection.

Mass effect from the collection, giving rise to a Page kidney. 

Given clinical status and after multi-disiplinary discussion, CT guided drainage performed.

Patient unable to lie prone.  Lateral position used for drainage.

Bone window allows needle, wire and drain to be easily visualised.

Seldinger technique used. 8F drain inserted using CT fluroscopy.

90mls blood stained pus aspirated on table and drain left in situ.

Case Discussion

Retroperitoneal collection

Patient with large body habitus

Poorly cooperative patient

Ideal candidate for CT guided drainage.

Related articles

Acute pyelonephritis

Page kidney

CT guided percutaneous drainage

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Case Information

rID: 22292
Case created: 25th Mar 2013
Last edited: 15th Dec 2015
Inclusion in quiz mode: Included

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