Spontaneous Nephrocutaneous Fistula in Xanthogranulomatous Pyelonephritis — A Rare Complication

The formation of fistulous tract between the kidney and adjacent organs is not uncommon while cutaneous fistulization is a rarer occurrence. We present a case of Nephrocutaneous Fistula without prior history of surgery or interventional procedure. Our case involves long standing obstructive pyonephrosis secondary to obstructing calculus at the ureteropelvic junction which led to formation of a fistulous tract upto the skin surface. This patient had complaints of purulent discharge from the right flank region associated with fever spikes since the last 1 month. The cutaneous manifestation in specific location should raise the possibility of underlying renal pathology

Fistula reno-apendicular como presentación inusual de pielonefritis xantogranulomatosa: reporte de caso / Reno-appendicular fistulus as an unusual presentation of xanthogranulomatous pyelonephritis: a case report

Resumen La fístula uro-entérica es una comunicación patológica entre la vía urinaria y digestiva. El compromiso del apéndice es infrecuente y son pocos los casos de fístulas reno-apendiculares en la literatura. Se presenta el caso de un paciente con clínica de fiebre, dolor lumbar e hidronefrosis derecha severa secundaria a cálculo coraliforme en la tomografía de vías urinarias. Manejado inicialmente con antibióticos y nefrostomía bajo fluoroscopia, posteriormente suspendida por paso de contraste al intestino. Se realizó una tomografía contrastada que reportó fístula del riñón al intestino. Se llevó a nefrectomía y se encontró fistula hacía el apéndice, por lo cual se realizó apendicectomía concomitante con mejoría clínica evidente. La patología reportó pielonefritis xantogranulomatosa y apendicitis secundaria. La fístula reno-apendicular posee una clínica inespecífica, la tomografía contrastada es una herramienta diagnóstica y la mayoría se detectan como un hallazgo intraoperatorio. El tratamiento usualmente es quirúrgico, con nefrectomía y reparación del segmento intestinal. MÉD. UIS.2021;34(3): 79-84.

Abstract Uro-enteric fistula is a pathological communication between the urinary and digestive tract. Compromise of the appendix is infrequent and few cases of reno-appendicular fistulas have been described in the literature. The case of patient with symptoms of fever, low back pain and severe right hydronephrosis secondary to staghorn calculus on urinary tract tomography is presented. Initially managed with antibiotics and nephrostomy under fluoroscopy, subsequently suspended by passing contrast to the intestine. A contrasted tomography was performed which reported a fistula from the kidney to the intestine. A nephrectomy was carried out and a fistula was found to the appendix, for which a concomitant appendectomy was performed with evident clinical improvement. The pathology reported xanthogranulomatous pyelonephritis and secondary appendicitis. Reno-appendicular fistula has nonspecific symptoms, contrasted tomography is a diagnostic tool and most are detected as an intraoperative finding. Treatment is usually surgical, with nephrectomy and intestinal segment repair. MÉD.UIS.2021;34(3): 79-84.

Xanthogranulomatous pyelonephritis and renal tubulopapillary adenomas: A rare coexistence.

Xanthogranulomatous pyelonephritis is an uncommon inflammatory condition accounting for 1% of chronic pyelonephritis cases. Clinically and radiologically it mimics other renal space occupying lesions. Hence, correct preoperative diagnosis is not possible in all cases and nephrectomy is done in most patients. Renal tubulopapillary adenomas are benign epithelial lesions of kidney found to be associated with papillary renal cell carcinoma, acquired renal cystic disease, long term hemodialysis, arteriosclerotic renal vascular disease, etc. Here, we report two cases of Xanthogranulomatous pyelonephritis associated with the rare finding of renal tubulopapillary adenomas.

Pielonefritis Xantogranulomatosa / Xanthogranulomatous Pyelonephritis

Introducción: la pielonefritis xantogranulomatosa es una enfermedad infecciosa, inflamatoria, crónica e inusual que afecta el parénquima renal. El tratamiento definitivo es la nefrectomía. Objetivos: presentar un nuevo caso de pielonefritis xantogranulomatosa, así como la secuencia diagnóstica y terapéutica adoptada. Métodos: paciente masculino de 61 años de edad, con antecedentes de hipertensión arterial, diabetes mellitus tipo II e infecciones urinarias a repetición, que asistió al cuerpo de guardia del Hospital Militar Central Dr. Luis Días Soto, por presentar dolor lumbar y en flanco derechos, de 2meses de evolución, intenso y punzante, asociado a fiebre de 40̊ C, escalofríos y marcada toma del estado general. En el examen del hemiabdomen derecho presentaba una masa tumoral de unos 10cm de diámetro, dolorosa, ligeramente movible y de superficie lisa. El urocultivo reportó Escherichiacoli. El ultrasonido abdominal evidenció una imagen compleja en el riñón derecho, y la tomografía axial computarizada un tumor heterogéneo, que medía 10,7x7, 6 cm de contornos regulares, que distorsionaba la grasa perirrenal con densidades de hasta 73 UH. Resultados: el paciente fue sometido a nefrectomía total derecha transperitoneal, por sospecha de tumor renal, proceder que transcurrió sin complicaciones. Los hallazgos microscópicos de la pieza quirúrgica revelaron infiltración de linfocitos, histiocitos y macrófagos llenos de lípidos, compatible con pielonefritis xantogranulomatosa. La evolución fue satisfactoria. Conclusiones: aunque el diagnóstico definitivo de la pielonefritis xantogranulomatosa es histopatológico, la forma tumoral de presentación de la misma, es uno de los diagnósticos diferenciales a tener en cuenta en pacientes diabéticos con infecciones recurrentes del tracto urinario(AU)

Introduction: Xanthogranulomatous pyelonephritis is an infectious, inflammatory, chronic, and unusual disease that affects the renal parenchyma. The definitive treatment is nephrectomy. Objectives: Present a new case of xanthogranulomatous pyelonephritis, as well as the diagnostic and therapeutic sequence adopted. Methods: A 61-year-old male patient with a history of hypertension, type II diabetes mellitus and recurrent urinary tract infections attended Dr. Luis Díaz Soto Central Military Hospital, for presenting intense and stabbing lumbar and right flank pain, of 2 months of evolution, associated with fever of 40 ° C, chills and marked the general condition. In the examination of the right abdomen a tumor mass was found of about 10 cm in diameter, painful, slightly movable and of smooth surface. The urine culture reported escherichiacoli. Abdominal ultrasound showed a complex image in the right kidney, and computed tomography scan showed a heterogeneous tumor, measuring 10.7x7.6 cm of regular contours, distorting the perirenal fat with densities of up to 73 UH. Results: The patient underwent transperitoneal right total nephrectomy, due to suspicion of renal tumor. This procedure had no complications. Microscopic findings of the surgical specimen revealed infiltration of lymphocytes, histiocytes, and lipid-filled macrophages, consistent with xanthogranulomatous pyelonephritis. The evolution was satisfactory. Conclusions: Although the definitive diagnosis of xanthogranulomatous pyelonephritis is histopathological, the tumoral presentation form is one of the differential diagnoses to be considered in diabetic patients with recurrent urinary tract infections(AU)

Xanthogranulomatous Pyelonephritis (XGPN) in a Child with Multiple Ureteric Calculi.

Xanthogranulomatous pyelonephritis (XGPN) is an unusual suppurative granulomatous reaction to chronic renal infection, often in the presence of chronic obstruction, characterised histologically by granulomatous reaction with giant cells and foamy histiocytes1. XGPN is rare in children2. We report a case of XGPN, in a child with multiple lower ureteric calculi. An 11 year old male child presented to us, with features suggestive of acute pyelonephritis of two months duration.complete evaluation including contrast CT of the abdomen a diagnosis of XGPN was made. As the renal unit in question was non functional, he was treated successfully by subcapsular nephrectomy. This case is presented to emphasise the fact that, it is very important to diagnose XGPN early and differentiate it from chronic pyelonephritis. Prolonged antibiotic therapy and surgery is invariably required to relieve the obstruction and to eradicate the infection in patients with XGPN.

Pielonefritis xantogranulomatosa en pediatría / Xantoranulomatous pyelonephritis in children

Se presenta el caso clínico de un pre-escolar masculino de 2 años de edad, con antecedentes de infección urinaria a repetición y fiebre no cuantificada de varios días de evolución. Ingresa con temperatura de 38,5°C, aumento de volumen en región lumbar izquierda de 4 cms de diámetro, blanda, no dolorosa, bordes no bien definidos, Se practican exámenes complementarios concluyendo de que se trata de patología tumoral renal izquierda. Se realizó laparotomía, donde se evidencio riñón izquierdo con cápsula lisa, adherida a la superficie pequeños nódulos amarillentos, indurados en toda su extensión a predominio del borde externo; se practicó nefrectomía izquierda. Presento postoperatorio sin complicaciones, egresando en buenas condiciones generales con diagnóstico anatomopatológico de Pielonefritis Xantogranulomatosa.

We report the case of a 2 years old male infant, with a history of recurrent urinary tract infection and high temperature during several days. On admission he had a temperature of 38.5 ° C and a soft, non-tender, well-defined 4 cm mass in the left lumbar region. Preoperative tests suggested the presence of a left renal tumor for which a laparotomy was performed with the following finding; left kidney with a smooth capsule with small yellow hard nodules adhered to its surface along the extension of the outer edge. A left nephrectomy was performed. He had an uneventful postoperative period and was discharged in good general condition. The pathological study reported a Xanthogranulomatous Pylonephritis.

Pielonefritis xantogranulomatosa en un adolescente / Xanthogranulomatous pyelonephritis in an adolescent

Se presenta el caso clínico de un adolescente de 15 años de edad, con antecedente de piodermitis, quien fue remitido al Hospital Docente Pediátrico Sur de Santiago de Cuba por presentar fiebre, dolor lumboabdominal del lado derecho y afectación del estado general. Desde los puntos de vista clínico e imagenológico se diagnosticó un tumor en el riñón derecho, lo cual obligó a realizarle una nefrectomía de dicho riñón. Los hallazgos anatomopatológicos confirmaron la presencia de pielonefritis xantogranulomatosa.

The case report of a 15 year-old adolescent is presented, with a history of pyodermitis who was referred to the Southern Children Teaching Hospital from Santiago de Cuba for presenting with fever, right lumbar abdominal pain and a compromised general status. From the clinical and imaging points of view a tumor was diagnosed in the right kidney, which forced to perform a nephrectomy of this kidney. The pathological findings confirmed the presence of xanthogranulomatous pyelonephritis.

Laparoscopic nephrectomy for xanthogranulomatous pyelonephritis: are there predictive factors for success?

OBJECTIVES: Laparoscopic nephrectomy for xanthogranulomatous pyelonephritis is currently associated with great operative difficulty and surgical complications. Herein, we report on our single-center experience and describe predictive factors for successfully accomplishing this procedure. METHOD: Between March 1998 and April 2010, 66 patients (27 men and 39 women) underwent laparoscopic nephrectomy for the treatment of a unilateral nonfunctioning kidney. These patients had previous diagnoses of renal chronic inflammation associated with calculi and previous pyonephrosis. All of the nephrectomies were performed using the transperitoneal approach, and a similar technique was used for radical nephrectomy. RESULTS: Laparoscopic nephrectomy for the treatment of renal chronic inflammation was successful in 58/66 cases (87.9%). Eight cases were converted to the open technique because of difficulty in progression, which was related to the discovery of dense adhesions in the hilar or perirenal region. One major (colonic lesion) and two minor (wound infection) complications occurred in the conversion group. A diagnosis of xanthogranulomatous pyelonephritis was confirmed pathologically for all of the specimens. Of the factors examined, a longitudinal renal length greater than 12 cm (laparoscopy group - 7.2±1.8 cm, versus open group - 13.6±1.5 cm; p<0.05) and time to access the renal vessels (laparoscopy group - 32±18 min, versus open group - 91±11 min; p<0.05) were associated with a higher conversion rate. Although the number of patients in the conversion group was small, the majority of these patients received right-sided nephrectomy. CONCLUSIONS: Laparoscopic nephrectomy for the treatment of xanthogranulomatous pyelonephritis is feasible and associated with low levels of morbidity. Factors including the time required to control the renal vessels, renal length and right-sided nephrectomy were associated with higher chances of conversion into an open procedure.

Pielonefritis xantogranulomatosa: Nuestra experiencia en 6 casos / Xanthogranulomatous pyelonephritis: Six case reports

Introducción. La pielonefritis xantogranulomatosa (PX) es una forma de infección crónica del parénquima renal. Objetivos. Describir las características imagenológicas de la PX. Materiales y Métodos. Se realizó un análisis retrospectivo de una serie de 6 casos de PX confirmados. Resultados. Se describieron los hallazgos imagenológicos de los casos mencionados. Discusión. Las manifestaciones clínicas sugieren la afección renal y las imágenes orientan hacia su probable diagnóstico. El proceso se extiende frecuentemente al espacio perirrenal. La TC es muy útil, ya que los hallazgos de la ecografía y la urografía pueden ser inespecíficos. En la TC, la PX se asocia con la presencia de un gran cálculo, un aumento del tamaño renal o de un segmento, la pobre o nula eliminación del medio de contraste y la presencia de masas focales de baja atenuación (-10 a +30 UH), cuyas paredes realzan con la administración del contraste endovenoso. Conclusiones. El diagnóstico se sospecha cuando se combinan la unilateralidad, la presencia de litiasis, el aumento de tamaño del riñón, la ausencia de eliminación del medio de contraste, la presencia de masas de baja atenuación y la afectación del espacio perirrenal.

Introduction. Xanthogranulomatous Pyelonephritis (XP) is a chronic infection of the renal parenchyma. Objectives. To analyze the imaging features of XP. Materials and Methods. We conducted a retrospective analysis of 6 confirmed cases of XP. Results. We described the imaging findings of the abovementioned cases. Discussion. Clinical manifestations suggest renal disease and imaging leads to probable diagnosis. The process often extends to the perirenal space. CT is very useful because sonographic and urographic findings may be nonspecific. In CT scans, XP is associated with the presence of a large calculus, enlargement of the kidney or of a segment , poor or no elimination of the contrast agent and the presence of focal masses of low attenuation (-10 to 15UH) whose walls are enhanced after the administration of intravenous contrast. Conclusions. Diagnosis is suspected when there is a combination of unilaterality, lithiasis, increased size of the kidney, no elimination of contrast medium, masses of low attenuation and perirenal space involvement.

El signo de la pata de oso En TC / The bear paw sign on CT scans

The "bear paw sign" is an unusual radiologic finding indicating xantogranulomatous pyelonephritis (XGP). It refers to the replacement of the renal parenchyma by necrotic areas or xanthomatous collections with a pattern mimicking hydronephrotic calyx dilatation, associated with peripheral enhancing of the renal cortex after intravenous contrast administration. This sign can be observed on computed tomography (CT) scannings, where the cross-sectional appearance of the kidney resembles the paw of a bear and necrotic areas mimic the toe-pads of the paw. Depending on the presentation of the disease (i.e., focal or diffuse), a differential diagnosis considering tumor-like renal cell carcinomas or fibrolipomatous replacement of the kidney has to be performed. A proper recognition of the "bear paw sign" on CT scans enables the radiologist to establish the diagnosis of XGP.

El signo de la "pata de oso" es poco habitual de observar en la práctica radiológica. Representa el reemplazo de parénquima renal por áreas necróticas o colecciones xantomatosas, con un patrón que simula dilatación caliciliar hidronefrótica asociado a realce periférico de la corteza renal tras la administración de contraste intravenoso. Este signo se describe en tomografía computada (TC) donde cada cojinete de los dedos representa dichas áreas necróticas y es característico de la pielonefritis xantogranulomatosa (PXG). Según la presentación de la pielonefritis (focal o difusa), es necesario realizar un diagnóstico diferencial con lesiones tumorales como el carcinoma de células renales o el reemplazo fibrolipomatoso del riñón. El reconocer el signo de la "pata de oso" en TC permite al radiólogo establecer el diagnóstico de PXG.

Emphysematous and xanthogranulomatous pyelonephritis: rare diagnosis

Pyelonephritis is a pyogenic infection of renal parenchyma that involves the renal pelvis. It is generally of easy diagnosis. The present case report aims to describe two different manifestations of this infection: xanthogranulomatous pyelonephritis and emphysematous pyelonephritis, which have poor prognosis and require a more effective treatment. The two cases were women in the fiftieth and sixtieth decade of life, with diabetes mellitus and history of weight loss. The diagnosis of the renal infection was established through computed tomography and the treatment was based in surgical procedure, with favorable outcome.

Xanthogranulomatous Pyelonephritis.

Xanthogranulomatous pyelonephritis (XPN) is an variant of chronic pyelonephritis difficult to differentiate from renal malignancy on preoperative evaluation.We report an unusual case of XGP occurring in an immunocompetent patient in the absence of either urinary obstruction or nephrolithiasis, presenting as a diagnostic dilemma.

Pielonefritis xantogranulomatosa: conceptos actuales en el diagnóstico y tratamiento / Xanthogranulomatous pyelonephritis: current concepts of diagnosis and treatment

Introducción: La Pielonefritis Xantogranulomatosa (PNF XG) es una patología de baja prevalencia, frecuentemente asociada a litiasis y destrucción del parénquima renal. Dada la gran masificación de la tomografía axial computada su diagnóstico y manejo es cada vez más precoz disminuyendo así la morbi-mortalidad perioperatoria. Objetivos: Describir la experiencia de nuestro servicio en PNF XG y realizar un análisis de la literatura sobre los conceptos actuales en el diagnóstico y tratamiento de esta patología. Materiales y métodos: Análisis retrospectivo de todas la nefrectomías totales realizadas en nuestro servicio entre los años 2000 y 2007. Se incluyeron sólo las piezas con el diagnóstico histológico de PNF XG. Resultados: Se encontraron 11 casos con el diagnóstico histológico de PNF XG. La edad promedio de presentación fue de 54 años con una leve tendencia al sexo femenino. En todos los pacientes se encontró una historia actual o reciente de litiasis urinaria. En todos los casos se realizó un estudio imagenológico preoperatorio, siendo 9 de ellos estudiados con TAC de abdomen y encontrándose la presencia de litiasis en 7 pacientes. Todos los pacientes fueron manejados mediante una nefrectomía total por lumbotomía, sin registrarse mortalidad. Conclusiones: La PNF XG constituye un desafío en sí misma. A pesar de ser una patología rara y de difícil diagnóstico, una cuidadosa evaluación preoperatoria y alto índice de sospecha, pueden ayudarnos a realizar un diagnóstico oportuno y realizar el manejo más adecuado, disminuyendo así las complicaciones perioperatorias.

Introduction: Xanthogranulomatous pyelonephritis (XG PNF) is a low prevalence disease, often associated with lithiasis and renal parenchymal destruction. The wide availability of tomographic (CT) diagnosis allows for frequent early management decreasing perioperative morbidity and mortality. We describe the experience at our institution in XG PNF and perform an analysis of the literature onthe current concepts in diagnosis and treatment of this condition. Materials and methods: Retrospective analysis of all nephrectomies performed at our department between 2000 and 2007. Only surgical specimens with histological diagnosis of XG PNF were included. Results: We found 11 cases with histologic diagnosis of XG PNF. Average age of presentation was 54 years with a slight tendency towards females. All patients had a current or recent history of urolithiasis. In all cases a preoperative imaging study was made, 9 of them were studied with abdominal CT scan and found the presence of stones in 7 patients. All patients were treated by an open total nephrectomy without mortality. Conclusions: The XG PNF is a challenge in itself. Despite being infrequent and difficult to diagnosis, a careful preoperative evaluation and a high index of suspicion can help to make an early diagnosis and management, thus reducing perioperative complications.

Urachal Xanthogranuloma: Laparoscopic Excision with Minimal Incision

Urachal xanthogranuloma is an extremely rare disease. A 23-year-old man presented with severe lower abdominal pain and voiding frequency. Computed tomography revealed a urachal mass with bladder invasion, which was suspected to be a urachal carcinoma or abscess. Laparoscopic urachal resection was performed with a minimal incision. Histopathologic examination identified the mass as a urachal xanthogranuloma.

18F-FDG PET/CT Finding in a Case of Xanthogranulomatous Pyelonephritis / 핵의학분자영상

Xanthogranulomatous pyelonephritis is an uncommon chronic renal infection, which is usually found on middle-aged women and is rare in infant. Sometimes it forms focal mass like lesion of kidney with pathologically characteristic lipid-laden macrophage. A 1-month female infant was admitted for fever and moaning sound. On work-up of urinary tract infection, abdomen ultrasonography and computed tomography revealed a large mass on the upper portion of right kidney and PET/CT showed homogeneously increased 18F-FDG uptake. The radical nephrectomy of right kidney was performed and histology revealed a focal xanthogranulomatous pyelonephritis. To our knowledge, this is the first report presenting the finding of 18F-FDG PET/CT in the childhood xanthogranulomatous pyelonephritis.

Xanthogranulomatous Pyelonephritis with Spontaneous Nephrocutaneous Fistula / 대한비뇨기과학회지

Fistula formation between the upper urinary tract and cutaneous tissue is an uncommon complication in urogenital disease. Xanthogranulomatous pyelonephritis(XGP) is a severe, chronic infection of the renal parenchyma that is often associated with calculi and obstruction. We present a rare case of XGP with a nephrocutaneous fistula.

A Case of Bilateral Xanthogranulomatous Pyelonephritis with Renal Failure / 대한신장학회지

Xanthogranlomatous pyelonephritis is a rare chronic inflammatory renal disease. Its clinical and radiological findings resemble other renal parenchymal diseases, such as a renal abscess or renal cell carcinoma. Only a histologic examination can confirm xanthogranulomatous pyelonephritis. It usually presents unilaterally and displays relatively normal renal function. Bilateral xanthogranulomatous pyelonephritis is extremely rare. The renal function of bilateral xanthogranulomatous pyelonephritis is usually normal at the time of diagnosis, but progresses to end stage renal failure as the disease progresses. We experienced a case of bilateral xanthogranulomatous pyelonephritis, and its initial manifestation was renal failure. We report this case with a review of the literatures.

Xanthogranulomatous Pyelonephritis in an Infant / 대한비뇨기과학회지

Xanthogranulomatous pyelonephritis (XGP) is an uncommon, severe, chronic infection of the kidney, which results in the normal renal parenchyma being replaced by characteristic lipid-laden macrophages (foam cells). It can occur at any age, but is extremely rare in children. Herein, the case of a 6-month-3-week-old girl with XGP, pre-operatively diagnosed with a Wilms' tumor, is reported. This is the youngest age of any patient with such a condition reported in the Korean literatures. Excretory urography, abdominal sonogram, computed tomogram and magnetic resonance imaging revealed a right renal round mass, without any calcifications. Her pathological findings after a radical nephrectomy revealed XGP.

Xanthogranulomatous Pyelonephritis in a Child / 대한비뇨기과학회지

Xanthogranulomatous pyelonephritis (XGP) is a rare, severe, chronic infection of the kidney resulting in the normal renal parenchyma being replaced by characteristic lipid-laden macrophages (foam cells). It may occur at any age but is extremely rare in children. Correct pre-operative diagnosis is essential for appropriate surgical approach. We report a case of diffuse XGP in a 6-year-old boy which was pre-operatively diagnosed as XGP.

Clinical Characteristics of Xanthogranulomatous Pyelonephritis / 대한비뇨기과학회지

PURPOSE: In most cases, xanthogranulomatous pyelonephritis (XGP) is diffusely or focally enlarged, mimicking a neoplastic process. The purpose of this study was to improve the preoperative diagnosis of this disease. MATERIALS AND METHODS: The clinical characteristics, laboratory and radiological findings, preoperative diagnoses and operative methods of 13 patients with XGP, who underwent an operation between 1979 and 2004, were retrospectively reviewed. All patients had undergone intravenous pyelography(IVP) and ultrasonography. Their mean age was 51+/-3.3 years (range 30 to 71), with a male to female ratio of 4 to 9. RESULTS: All 13 patients had flank pain, 8(61.5%) had a urinary tract infection and 9(69.2%) with benign renal disease preoperatively underwent a simple nephrectomy. Four patients preoperatively diagnosed with a renal cell carcinoma(RCC) underwent a radical nephrectomy. 3 patients had extended to the psoas muscle. On the basis of the ultrasonographic features: (1) 6(46.1%) were diffuse hydronephrotic; (2) 4(30.8%) were diffuse parenchymal; (3) 2(15.4%) were diffuse contracted, and (4) 1(7.7%) was segmental or focal. On the basis of the computed tomography(CT) features, the diffuse or global forms(88.9%) were more common than the localized or focal forms(11.1%). Diffuse XGP may be staged as follows: Stage I(25%), involvement is limited to the kidney; Stage II(50%), involvement extends to the perirenal fat within Gerota's fascia; Stage II(25%), involvement extends beyond the Gerota's fascia into another organ. CONCLUSIONS: Preoperative diagnosis of XGP will be raised through a better understanding of the characteristics and radiological findings of this disease.