Empyema Resulting From a Nephro-Pleural Fistula in an Adult With Polycystic Kidney Disease With Obstructive Uropathy.

Nephropleural fistula, a rare complication of percutaneous nephrolithotomy (PCNL), occurred in a 45-year-old male with adult autosomal dominant polycystic kidney disease (ADPKD). The patient had undergone right PCNL in 2021 and 2023 and presented to the emergency department with symptoms of fever, breathlessness, and cough lasting one week. Imaging studies, including chest radiograph and contrast-enhanced computed tomography (CECT) of the abdomen and pelvis, revealed gross right pleural effusion, right perinephric abscess, multiple renal cysts, right renal calculi and right ureteric calculi causing severe right hydronephrosis and proximal hydroureter. The imaging also confirmed a nephropleural fistula, with the right kidney's perinephric abscess communicating with the right pleura via the right subhepatic space. Subsequent thoracic ultrasound showed a large effusion of 1500ml with underlying lung collapse. Diagnostic thoracocentesis confirmed empyema, necessitating immediate tube thoracostomy. CT intravenous urography confirmed a non-functioning right kidney. The perinephric abscess was drained with a PCNL tube and meanwhile, pleural fluid and perinephric abscess isolated Klebsiella pneumonia on cultures. The patient received parenteral antibiotics and intravenous fluids and had an intercostal drain and PCNL tube in place for drainage. A right nephrectomy was recommended due to the non-functioning right kidney and the patient is awaiting the procedure.

Retroperitoneal biloma-A rare differential diagnosis of perirenal fluid accumulation.

Introduction: Nontraumatic biliary rupture and retroperitoneal biloma infrequently occur. Here, we report a case of retroperitoneal biloma due to spontaneous left hepatic duct perforation, which was difficult to differentiate from a perirenal abscess. Case presentation: A 94-year-old female patient was hospitalized with symptoms of fatigue and right back pain that lasted for 5 days. Computed tomography revealed fluid accumulation in the retroperitoneum, and urinary extravasation and right perinephric abscess were suspected. Antimicrobial treatment and drainage with ureteral stents and urethral catheters demonstrated no symptom improvement. Ultrasound-guided puncture of the abscess revealed the presence of bile. Pigtail catheter drainage improved symptoms and inflammatory response. After diagnosis, endoscopic retrograde cholangiopancreatography revealed bile leakage, and a bile duct stent was inserted. Conclusion: Biloma can cause perirenal fluid accumulation, and they should be considered an origin of perirenal fluid accumulation when urinary tract lesions are excluded.

Isolated perinephric abscess as the initial manifestation of filariasis-an unusual presentation.

Key Clinical Message: Filariasis may present as an isolated perinephric abscess. Hence, a high index of suspicion should be maintained in endemic settings. Abstract: In cases with unexplained fever, eosinophilia and perinephric collection, it is necessary to do detailed infectious disease work up. High index of suspicion is required to diagnose filariasis due to its wide range of clinical presentation and laboratory findings. It may present as perinephric abscess, which can be diagnosed through ultrasonography.

Perinephric Abscess Extending to the Psoas Muscle and Causing a Nephro-Cutaneous Fistula.

We present a case of a 76-year-old male with dementia transferred from a nursing home with a fever and an abscess on his back. Workup revealed an extensive perinephric abscess, which extended to his psoas muscle, with an additional fistula to his back where the abscess was noted. The extent and tracking of the perinephric abscess were unusual as well as the organisms isolated, Citrobacter koseri and Bacteroides species.

Spermatic cord abscess: Case report and imaging findings.

Spermatic cord abscess is a rare condition usually associated with other genitourinary infections. We present a case of a 49-year-old male with past medical history of uncontrolled diabetes mellitus. He presented with right groin swelling and pain for a week. Ultrasound showed a tubular hyperemic structure extending into the scrotal sac. Computed tomography showed concurrent perinephric abscess and right spermatic cord abscess. The spermatic cord abscess was managed surgically by incision and drainage. To our knowledge, this is the first case report of a patient with spermatic cord abscess and concurrent perinephric abscess. We highlight the clinical importance of familiarity with such a rare condition and the role of imaging in establishing the correct diagnosis while excluding close differentials.

Percutaneous nephroscopy combined with ultrasound-guided negative-pressure suction for the treatment of perinephric abscess: a case series.

BACKGROUND: Drainage is indicated in many patients with a perinephric abscess (PA). Surgical drainage is associated with trauma and slow recovery, while percutaneous drainage can be ineffective in some patients. We report on 11 patients with PA treated by percutaneous nephroscopy combined with ultrasound-guided negative-pressure suction under local anesthesia. METHODS: This case series included 11 PA patients operated on from January 2013 to June 2020. All patients received percutaneous nephroscopy combined with ultrasound-guided negative-pressure suction. Data, including operation time, volume of intraoperative blood loss, volume of intraoperative pus suction, time of postoperative drainage tube indwelling, time to restore normal body temperature, length of postoperative hospital stay, and intraoperative and postoperative complications, were collected. RESULTS: The age of the patients was 59 (53-69) years. Eight, six, two, and two patients had hypertension, type 2 diabetes, rheumatoid arthritis, and renal calculi, respectively. The operations were successful forall11 patients. Eight, two, and one patients required one, two, and three channels, respectively, to clear their abscess. The average operation time was 44 (30-65) min, and intraoperative blood loss was 16 (10-20) ml. The volume of intraoperative pus suction was 280 (200-400) ml, time of postoperative drainage tube indwelling was 8.2 (6-12) days, and time to restoring normal body temperature was 0.8 (0.5-2) days. The average postoperative hospital stay was 9.8 (7-14) days. No severe intraoperative or postoperative complications occurred. The postoperative follow-up time was typically 4.8 (3-8) months, and there were no recurrences. CONCLUSION: Percutaneous nephroscopy combined with ultrasound-guided negative-pressure suction might be a feasible method for treating PA.

Renal actinomycosis with muscular invasion post-nephrostomy tube placement.

Perinephric abscesses are a rare complication of nephrostomy tube placement. There are several aerobic bacteria that are common culprits of abscess formation. Here we describe a novel report of a perinephric abscess due to Actinomyces odontolyticus. We describe the presentation of illness, imaging and clinical findings, and the prolonged treatment course needed for this medically complex patient.

Successful treatment of giant perinephric abscess associated with decompensated cirrhosis caused by hepatitis B and alcohol consumption: A case report.

We describe the case of a 67-year-old male with decompensated liver cirrhosis caused by hepatitis B virus and alcohol consumption who presented with diarrhea and fever. Contrast CT of the abdomen revealed giant perirenal abscess. Klebsiella pneumoniae ssp pneumoniae was cultured from pus in perirenal abscess but not the blood. Haematogenous spread may have resulted in perirenal abscess in this case. The patient was successfully treated by percutaneous drainage, antimicrobial therapy and albumin infusion. With high mortality rates, early diagnosis and effectively treatment of perirenal abscess is required to improve the prognosis of patients.

Outcome of conservative and minimally invasive management in emphysematous pyelonephritis.

CONTEXT: Developing countries. INTRODUCTION: Emphysematous pyelonephritis (EPN) is a urologic emergency characterized by acute necrotizing infection with the presence of gas in the kidney, perinephric space, and/or urinary collecting system. MATERIALS AND METHODS: It is a retrospective study of inpatients at the Department of Urology, RG Kar Medical College and Hospital, Kolkata, which includes twenty patients diagnosed as EPN between September of 2018 and May of 2020. RESULTS: Patients were classified as per computed tomography (CT) severity grading proposed by Huang and Tseng. In our study, medical management with antibiotics was effective in 10% of patients. Twenty percent of patients were treated with medical management and internal ureteral stenting. Fifty percent of the patients were treated with medical management and percutaneous nephrostomy (PCN). Ten percent needed PCN drainage in addition to Double J (DJ) stenting. Ten percent needed percutaneous drainage of perinephric abscess along with PCN. Ten percent of patients were treated with open drainage in addition to DJ stenting and percutaneous drainage of perinephric collection as they failed to respond to minimally invasive intervention alone, with repeat ultrasonography showing persistent collection. There was no mortality in the group. CONCLUSION: EPN patients are mostly moribund with multiple comorbidities. It is vital to comprehend the management with a prompt CT imaging. Proactive hemodynamic stabilization, antimicrobial therapy, complementing it with DJ stenting and/or PCN in cases not responding to antibiotics alone, can treat most of the patients with this pathology.

Metastatic subretinal abscess in a patient with perinephric abscess.

An 80-year-old lady with uncontrolled type 2 diabetes developed fever and abdominal pain followed by a sudden diminution of vision in her left eye. Right infra-renal abscess accounted for abdominal pain. A metastatic left subretinal abscess was diagnosed subsequently. Medical management for her systemic condition initiated. Vitreous biopsy was performed along-with intravitreal antibiotic administration. Because of no clinical recovery, patient underwent pars plana vitrectomy. Prompt systemic stabilization and a timely surgical intervention in the left eye resulted in a satisfactory visual gain. Metastatic subretinal abscess following a perinephric abscess is rare phenomenon and only a few cases are reported to date.

Renal and perinephric abscesses involving Lactobacillus jensenii and Prevotella bivia in a young woman following ureteral stent procedure.

 is a gram-positive bacillus in the female genital tract believed to be a commensal organism that inhibits the growth of more virulent pathogens. Prevotella bivia is a gram-negative bacillus species also typically commensal in the female genital tract. Lactobacillus as the primary causative agent in perinephric abscesses and bacteremia has been documented, albeit very uncommon and opportunistic. Prevotella bivia is not classically associated with perinephric abscesses but has been implicated in rare cases of pelvic inflammatory disease and tubo-ovarian abscesses. In this report, we present a 26-year-old immunocompetent woman with a recent history of nephrolithiasis treated with lithotripsy, ureteral stent placement and removal, and antibiotics who was admitted for fever and severe right flank pain. Imaging showed a right-sided renal and perinephric abscesses colonized by Lactobacillus jensenii and Prevotella bivia. Blood cultures were also positive for Lactobacillus species. Per literature review, intravenous ceftriaxone and metronidazole were administered with successful resolution of abscesses and negative repeat blood cultures. To our knowledge, this is the first case of simultaneous renal system abscesses caused by Lactobacillus and Prevotella species. Nephrolithiasis and prior antibiotics likely contributed to the opportunistic pathogenesis in this otherwise immunocompetent patient.

Perinephric abscess in a renal transplant recipient due to Mycoplasma hominis: Case report and review of the literature.

A 42-year-old man presented with nausea, malaise, and pain at his renal graft site 4 months following deceased donor renal transplant. His transplantation had been complicated by urinary leak with delayed wound closure requiring ureteral revision with biologic mesh placement. The initial evaluation in the hospital revealed urinalysis with significant pyuria as well as abdominal CT imaging concerning for abscess formation anterior to the grafted kidney. Interventional radiology (IR) guided drainage of this abscess yielded growth of Enterococcus faecalis treated with intravenous ampicillin/sulbactam. He continued to have pain at his graft site and repeat imaging revealed a persistent abscess despite prolonged antimicrobial therapy. Urine cultures isolated Mycoplasma species. A repeat aspirate of abscess fluid collected and Mycoplasma hominis was identified by molecular test. Patient's symptoms abated and his abscess completely resolved on repeat imaging after completing a course of oral moxifloxacin and doxycycline. His immunosuppression did not require adjustment and the renal graft continued to function well following this therapy. Mycoplasma and Ureaplasma should be considered as a potential etiology for perinephric abscess in renal transplant recipients.

Hiding in Plain Sight: A Case of Perinephric Abscess Diagnosed by POCUS.

An 87 year old male with obstructive uropathy was initially diagnosed with acute kidney injury (AKI), a new renal mass and hydronephrosis. When transferred to a facility with a hospital medicine POCUS program, the renal mass was correctly identified as a perinephric abscess, which was percutaneously drained leading to resolution of AKI and the underlying infection. Renal POCUS is readily taught via brief educational interventions and empowers providers to identify common (hydronephrosis) and uncommon (perinephric abscess) renal pathology at the bedside.

Necrosis of the duodenal wall with retroperitoneal perforation as a complication of perirenal abcess. Case report and management.

Duodenal perforation is a rare and severe acute surgical condition which commonly follows the complications of endoscopic and laparoscopic procedures. Small degree of damage in this mechanism and an early diagnosis allow for an effective primary management. The most difficult surgical challenge is an effective management of retroperitoneal duodenal perforation together with coexisting pathological changes of its wall. In this work we present a case of duodenal necrosis with excessive necrosis of a fragment of its wall due to perinephric abscess, with an effective method of management of a defect in an isolated free small intestinal loop in association with gastroduodenal passage exclusion.

Retroperitoneal ascariasis: A case report

@#Infection with adult Ascaris primarily occurs in the gastrointestinal system, but physical migrationother than this has been reported. To date, only a small number of cases have been reported to involvethe urinary system and no report of Ascariasis migration to the retroperitoneal space.This is a case of a 38-year-old female admitted as a case of perinephric abscess, renal mass right.Patient was initially managed conservatively with broad spectrum antibiotics and tube drainage, butwith the deteriorating condition, an exploratory laparotomy, with retroperitoneal exploration wasdone. During exploration, no colonic fistula was noted. The renal parenchyma was noted to bepinkish with a 1cm opening at the mid lateral pole associated with purulent discharge. Interestingly,a 6cm x 1cm wax-like, moving structure was found in the retroperitoneal space The object wasremoved with Debakey forceps and was determined to be Ascaris lumbricoides by histopathology.Fecal analysis of stool for ova and parasites was negative for Ascaris. The patient then had an uneventfulrecovery.Currently, there are only two theories on how Ascaris lumbricoides can be introduced into the urinarysystem. The first includes fistulation between the GI and urinary system and second by retrogrademigration of the adult worm through the urethra. Given the current data, the authors believe that thepatient experienced retrograde invasion of Ascaris through the urethra, and subsequently migrated tothe retroperitoneal space through fistulation.Ascariasis of the genitourinary tract is a rare condition. This is the first reported case of ascariasis inthe retroperitoneum.

Retroperitoneal abscess with subcutaneous extension: case report of a rare complication of percutaneous renal biopsy.

BACKGROUND: Infective complications following percutaneous renal biopsy are rare, even among immunocompromised. However it is important to be vigilant about such complications, to detect them early and prevent morbidity and mortality. We report a case of retroperitoneal abscess with extension to subcutaneous plane after a renal biopsy. CASE PRESENTATION: A 42-year-old female with long standing cutaneous lupus underwent renal biopsy for evaluation of nephrotic range proteinuria. She was on high dose prednisolone complicated with steroid induced hyperglycaemia. Eight weeks after the biopsy she presented with left flank pain, malaise and fever. There was a tender subcutaneous induration over the biopsy site. Contrast CT abdomen showed a retroperitoneal abscess with subcutaneous extension along the path of the biopsy needle. This was successfully treated with surgical drainage and broad-spectrum antibiotics. CONCLUSIONS: Infections and abscess formation are rare but serious complications of renal biopsy. Immunocompromised state is a potential risk factor. Possible mechanisms and measures for prevention and early detection of this rare complication are discussed.

Invasive Group B streptococcus: multiloculated perinephric abscesses treated with percutaneous drainage.

Group B streptococcus infections (GBSI) are commonly associated with neonates and pregnant women, but may also affect nonpregnant adults. Among its spectrum of manifestations, perinephric abscess (PA) is exceedingly rare. Comorbid conditions such as diabetes mellitus (DM) and immunosuppression increase the risk of GBSI. We describe a 61-year-old Vietnamese man with compensated alcoholic cirrhosis, who presented with acute encephalopathy following subacute, progressive abdominal pain. He was afebrile and hemodynamically stable. Laboratory data were remarkable for leukocytosis, thrombocytopenia, azotemia, and pyuria. He was found to have two right-sided PA measuring 15 × 10 × 11 cm and 4.6 × 2.7 × 7.8 cm, requiring interval placement of multiple percutaneous drains. Culture from abscesses revealed beta-hemolytic Group B streptococcus (GBS). His course was complicated by contiguous spread to abdominal wall and paraspinal musculature, as well as a new diagnosis of type 2 DM. Along with drainage, a prolonged course of intravenous antimicrobial treatment led to abscess resolution. Given the rising number of unusual clinical presentations of GBSI, this bacteria should be considered as a part of the microbiological differential diagnosis of PA, especially in conditions leading to immunosuppression.

Basidiobolomycosis complicated by hydronephrosis and a perinephric abscess presenting as a hypertensive emergency in a 7-year-old boy.

A 7-year-old boy presented with a chronic, indurated, tender left thigh swelling in association with a hypertensive emergency. He had a bilateral moderate degree of hydronephrosis and a left perinephric abscess, and MRI features of posterior reversible encephalopathy syndrome. Histopathological examination of the biopsy specimen demonstrated eosinophilic fasciitis with filamentous fungi. Basidiobolus ranarum was isolated from the culture. The fungus was also isolated from a perinephric fluid aspirate. Computerised tomography of the abdomen demonstrated features consistent with fungal invasion of the pelvic floor muscles and urinary bladder, leading to bilateral hydronephrosis. He required multiple antihypertensive drug therapy and was treated with intravenous amphotericin B, oral itraconazole and potassium iodide. Antihypertensive agents were discontinued after 2 weeks of antifungal therapy. At 6-months follow-up, the hydronephrosis had resolved completely. Perinephric abscess associated with basidiobolomycosis has not been reported previously.

Renal and perinephric abscesses in West China Hospital: 10-year retrospective-descriptive study.

AIM: To elucidate the clinical, radiological and laboratory profiles of renal abscess (RA) and perinephric abscess (PNA), along with related treatment and outcome. METHODS: Ninety-eight patients diagnosed with RA or PNA using the primary discharge diagnoses identified from the International Statistical Classification of Diseases and Related Health Problems Tenth Edition (ICD-10) codes (RA: N15.101, PNA: N15.102) between September 2004 and December 2014 in West China Hospital were selected. Medical records including patients' characteristics, symptoms and signs, high-risk factors, radiological features, causative microorganisms and antibiotic-resistance profiles, treatment approaches, and clinical outcomes were collected and analyzed. RESULTS: The mean age of the patients was 46.49 years with a male to female ratio of 41:57. Lumbar pain (76.5%) and fever (53.1%) were the most common symptoms. Other symptoms and signs included chills (28.6%), anorexia and vomiting (25.5%), lethargy (10.2%), abdominal pain (11.2%), flank mass (12.2%), flank fistula (2.0%), gross hematuria (7.1%), frequency (14.3%), dysuria (9.2%), pyuria (5.1%) and weight loss (1.0%). Painful percussion of the costovertebral angle (87.8%) was the most common physical finding. The main predisposing factors were lithiasis (48.0%), diabetes mellitus (33.7%) followed by history of urological surgery (16.3%), urinary tract infections (14.3%), renal function impairment (13.3%), liver cirrhosis (2.0%), neurogenic bladder (1.0%), renal cyst (1.0%), hydronephrosis (1.0%), chronic hepatitis B (1.0%), post-discectomy (1.0%) and post-colectomy (1.0%). Ultrasound (US) and computed tomography were the most valuable diagnostic tools and US was recommended as the initial diagnostic imaging choice. Escherichia coli (51.4%), Staphylococcus aureus (10.0%) and Klebsiella pneumoniae (8.6%) were the main causative microorganisms. Intravenous antibiotic therapy was necessary while intervention including surgical and nonsurgical approaches were reserved for larger abscesses, multiple abscesses, PNAs and non-responders. CONCLUSION: Heightened alertness, prompt diagnosis, and especially proper antibiotics in conjunction with interventional approaches allow a promising clinical outcome of renal and perinephric abscesses.