Presentation
Diabetic. Septic. Cause unidentified.
Patient Data
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 gives rise to an appearance of 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 in a patient with large body habitus drained under CT guidance.
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