الموقع الرسمي للدكتور أحمد رفاعي

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Case 4

1/2/2013

3 Comments

 
Picture
 





Findings:

 ·     Low attenuation fatty mass, replacing the right renal parenchyma, extends beyond the kidney into the perinephric space ( green arrow),  with loss of normal renal
outline, along with deformed appearance of the remaining part of the kidney which harbouring multiple stones ( yellow arrow ) and shows mild hydronephrosis ( white arrow )
 ·    Normal appearance of left kidney ( pink arrow ).

 Diagnosis:
Xanthogranulomatous     pyelonephritis  (XGP)

Teaching points:

 ·       XGP is a rare chronic suppurative form of renal infection due to chronic renal
obstruction ( calculus or stricture) resulting  in a non-functioning kidney
characterized by parenchymal destruction and replacement of the parenchyma with
lipid laden macrophages 
·       The kidney is eventually replaced by a mass of reactive tissue, surrounding the usually present calculus with associated  hydronephrosis  of a greater or lesser degree. Foamy (lipid laden) macrophages predominate .
·       Inflammatory process eventually extends into perinephric tissues and even adjacent organs.
 ·   Two forms are recognized, diffuse form ( 90% of cases ) , and focal form ( 10% of cases ) 
 ·       F:M = 4:1.   the  female predilection is  presumably relating to an increased incidence of urinary tract infections .


3 Comments
mohamed abdel aziz
1/2/2013 05:31:02 pm

great case .. Xanthogranulomatouspyelonephritis .. what a name ! :D

Reply
Dr.momen
1/6/2013 09:39:38 pm

Nice case dr. Ahmed , But can i reach this diagnosis with out contrast? As the cases of renal stones done usually with out contrast

Reply
Ahmed Refaey
1/6/2013 10:49:39 pm

sure dr Momen , in the diffuse form you can reach the diagnosis by plain study, as u can appreciate the renal stone and the fatty component as well as the hydronephrosis without IV contrast administration..but in the focal form , IV contrast is mandatory to differentiate it from other similar lesions like renal cell carcinoma.

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