Xanthogranulomatous pyelonephritis and nephro-pulmonary fistula

Case contributed by MD Gustavo Poletto

Presentation

Pelvic pain and dysuria, cough. Ex-smoker.

Patient Data

Age: 75 years
Gender: Female

 A chronic inflammatory process involving the right kidney, with multiple staghorn calculi filling the pyelocaliceal system. Atrophy of the renal parenchyma and urothelial thickening;  diffuse infiltration of the perirenal and periureteral fat planes as well as of the pararenal fascia. 

There is a trans-diaphragmatic fistulous tract between the upper pole of the right kidney and the posteroinferior region of the right hemithorax, with intrapulmonary stones in the posterior segment of the right lower lobe. Areas of consolidation in the lower lobe of the right lung around the stones. There is a small ipsilateral pleural effusion. 

Case Discussion

Xanthogranulomatous pyelonephritis (XGP) is a rare destructive inflammatory disease of the renal parenchyma usually caused by infection secondary to renal calculus disease. Inflammatory reaction with lipid-laden macrophages (xanthoma cells) causes progressive destruction of the medulla and cortex and is most often unilateral.

Involvement of the Psoas muscle, Diaphragm, Duodenum, Small bowel, Colon, and Lung with fistula formation has been described.

Authors

MD.Gustavo Poletto, Ivo M.Strimitzer, Marcos Gazzoni- Radiologists- Unimed Vale do Sinos- NH

MD. Vivian Cristofoli- Thoracic Surgeon- Unimed Vale do Sinos- NH

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