Xanthogranulomatous pyelonephritis with calculus migration into the psoas abscess: an unusual complication

Xanthogranulomatous pyelonephritis (XGP) is a rare variant of chronic pyelonephritis. It is characterized by progressive parenchymal destruction caused by chronic renal obstruction due to calculus, stricture, or rarely tumor, resulting in kidney function loss. Herein, we describe the case of a 36-year-old female who presented with left loin pain, left lower limb pain, and dysuria. On contrast-enhanced computed tomography (CECT), multiple abscesses and an obstructive staghorn calculus were depicted in the left kidney with the classical appearance of "Bear Paw Sign." An abscess with calculi was also present within the left psoas muscle. Though psoas muscle abscess in association with XGP was described, a ureteric fistula and calculi within the psoas muscle have not yet been reported in the literature. Left nephrostomy was performed, which came out to be positive for E. coli on culture. The patient underwent left nephrectomy, and the histopathological report of the surgical specimen confirmed XGP.

Trousseau's sign in the left internal jugular vein in gastric cancer

A 24-year-old woman came with complaints of upper abdominal swelling for the last 6 months, early satiety associated with loss of appetite and weight for 3 months, abdominal pain for the last 1 month, and vomiting for the last 4 days. Abdominal examination revealed a centrally placed solid swelling in the epigastric region with mild tenderness. Abdominal ultrasound and contrast-enhanced computed tomography (CECT) abdomen showed multiple liver secondaries and diffuse circumferential gastric wall thickening and enlarged peripancreatic and periportal nodes [Figure 1]. Ultrasound of neck and Doppler and CECT neck showed partial thrombus in the left internal jugular vein thrombosis (IJVT) proximal to its origin for a length of about 1.7 cm [Figure 2]a and [Figure 2]b. Upper gastrointestinal scopy showed ulceroproliferative growth in the body, antrum, and pylorus region with features of infiltrating adenocarcinoma of poorly differentiated diffuse type on biopsy.