RESUMO
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.
Assuntos
Abscesso/diagnóstico , Entomophthorales/isolamento & purificação , Hidronefrose/diagnóstico , Hipertensão/diagnóstico , Perinefrite/diagnóstico , Zigomicose/complicações , Zigomicose/microbiologia , Abscesso/patologia , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Anti-Hipertensivos/administração & dosagem , Biópsia , Criança , Histocitoquímica , Humanos , Hidronefrose/patologia , Hipertensão/tratamento farmacológico , Hipertensão/patologia , Itraconazol/administração & dosagem , Imageamento por Ressonância Magnética , Masculino , Microscopia , Perinefrite/patologia , Iodeto de Potássio/administração & dosagem , Radiografia Abdominal , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Zigomicose/tratamento farmacológicoAssuntos
Dor no Flanco/induzido quimicamente , Hematoma/induzido quimicamente , Nefropatias/induzido quimicamente , Linfoma de Célula do Manto/tratamento farmacológico , Pirazóis/uso terapêutico , Pirimidinas/uso terapêutico , Doença Aguda , Adenina/análogos & derivados , Feminino , Dor no Flanco/diagnóstico , Dor no Flanco/etiologia , Hematoma/complicações , Hematoma/diagnóstico , Humanos , Nefropatias/complicações , Nefropatias/diagnóstico , Pessoa de Meia-Idade , Perinefrite/induzido quimicamente , Perinefrite/complicações , Perinefrite/diagnóstico , Piperidinas , Trombocitopenia/induzido quimicamente , Trombocitopenia/complicações , Trombocitopenia/diagnósticoAssuntos
Bacteriemia/complicações , Bacteriemia/diagnóstico , Celulite (Flegmão)/diagnóstico , Perinefrite/diagnóstico , Urologia , Adolescente , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Bacteriemia/terapia , Celulite (Flegmão)/microbiologia , Celulite (Flegmão)/terapia , Diagnóstico Diferencial , Quimioterapia Combinada , Emergências , Transfusão de Eritrócitos , Glucocorticoides/uso terapêutico , Humanos , Masculino , Perinefrite/microbiologia , Perinefrite/terapia , Transfusão de Plaquetas , Fatores de Risco , Trombocitopenia/diagnóstico , Resultado do Tratamento , Vitiligo/complicaçõesRESUMO
Fusarium infections are important problem worldwide, cause a broad spectrum of infections in human including superficial infections as well as locally invasive and disseminated infections. We report a rare case of perinephric abscess caused by Fusarium chlamydosporum in a child who had a recent episode of pyelonephritis. This case illustrates the ever increasing spectrum of rare but offending pathogenic fungi in an immunocompetent host. Fungal infections should always be suspected in patients having one or the other underlying risk factor or who are unresponding to antibacterial therapy. Early diagnosis of infection with a specific pathogen may lead to changes in antifungal therapy and may be critical for an improved outcome.
Assuntos
Abscesso/diagnóstico , Abscesso/patologia , Fusariose/diagnóstico , Fusariose/patologia , Fusarium/isolamento & purificação , Perinefrite/diagnóstico , Perinefrite/patologia , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Antifúngicos/uso terapêutico , Criança , Fusariose/tratamento farmacológico , Fusariose/microbiologia , Humanos , Masculino , Técnicas Microbiológicas , Perinefrite/tratamento farmacológico , Perinefrite/microbiologiaRESUMO
Polyarteritis nodosa is a systemic vasculitis of medium and small-sized arteries associated with aneurysm formation. Aneurysms may be complicated by thrombosis, rupture and hemorrhage. Kidney involvement in polyarteritis nodosa can rarely be complicated by Wunderlich syndrome which is characterized by acute onset of spontaneous, nontraumatic subcapsular and perirenal hematomas. A 22-year-old woman with mental retardation due to childhood cytomegalovirus infection presented with flank pain, weight loss and fever, and was found to have bilateral subcapsular and perinephric hematomas. Spontaneous bilateral renal hemorrhage as the initial manifestation of polyarteritis nodosa is rare, and it can be associated with delays in diagnosis and treatment.
Assuntos
Hemorragia/diagnóstico , Rim/patologia , Perinefrite/diagnóstico , Poliarterite Nodosa/diagnóstico , Diagnóstico Diferencial , Feminino , Hemorragia/complicações , Humanos , Perinefrite/complicações , Poliarterite Nodosa/complicações , Adulto JovemRESUMO
The clinical condition of perinephric abscess can present dramatically as an acute emergency or insidiously as a chronic condition. The clinical characteristics and contemporary treatment approaches of these different types of perinephric abscess are outlined in this overview of the topic.
Assuntos
Abscesso/diagnóstico , Abscesso/terapia , Diagnóstico por Imagem/métodos , Perinefrite/diagnóstico , Perinefrite/terapia , Abscesso/microbiologia , Doença Aguda , Antibacterianos/uso terapêutico , Doença Crônica , Terapia Combinada , Drenagem/métodos , Diagnóstico Precoce , Feminino , Seguimentos , Humanos , Masculino , Perinefrite/microbiologia , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia DopplerRESUMO
A 67-year-old woman diagnosed with pyonephrosis and perinephric abscess because of an impacted urinary stone in the pelvicoureteric junction was admitted to the hospital with a high-grade fever. Although construction of a right nephrostomy for drainage of the abscess improved her general condition, she had a fever again 2 weeks after the initial treatment. Computed tomography revealed a persistent perinephric retroperitoneal abscess and a second drainage procedure was performed. Then, imaging examination revealed fistula formation between the cavity of the perinephric retroperitoneal abscess and the duodenum. The patient received conservative management including percutaneous drainage, discontinuation of oral intake, and antimicrobial chemotherapy. Three days after the second drainage and discontinuation of oral intake, imaging examination revealed complete closure of the fistula. Fistula formation between a perinephric abscess and the duodenum is very rare but a favorable outcome was obtained by our conservative management.
Assuntos
Abscesso Abdominal/complicações , Fístula do Sistema Digestório/terapia , Duodenopatias/terapia , Perinefrite/complicações , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/microbiologia , Idoso , Fístula do Sistema Digestório/complicações , Fístula do Sistema Digestório/diagnóstico , Duodenopatias/complicações , Duodenopatias/diagnóstico , Enterococcus faecalis/isolamento & purificação , Escherichia coli/isolamento & purificação , Feminino , Humanos , Cálculos Renais/complicações , Nefrostomia Percutânea , Perinefrite/diagnóstico , Perinefrite/microbiologia , Pionefrose/complicações , Pionefrose/diagnóstico , Pionefrose/cirurgia , Radiografia , Espaço Retroperitoneal/diagnóstico por imagem , Resultado do TratamentoAssuntos
Abscesso/diagnóstico , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/diagnóstico , Perinefrite/complicações , Perinefrite/diagnóstico , Quadriplegia/complicações , Quadriplegia/microbiologia , Stenotrophomonas maltophilia , Abscesso/complicações , Abscesso/prevenção & controle , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Infecções por Bactérias Gram-Negativas/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Perinefrite/prevenção & controleRESUMO
PURPOSE: We characterize the treatment and outcomes of perinephric abscesses in a contemporary cohort of patients. MATERIALS AND METHODS: We reviewed the experience with perinephric abscesses at a single community based hospital. Abdominal computerized tomography (CT) was widely available during the study period and experience with radiographic guided percutaneous drainage was extensive. Therapy and intervention for individual patients were dictated by the treating physician. RESULTS: Of the 25 patients identified with perinephric abscesses 3 (12%) ultimately died. Although 40% had multiple risk factors for perinephric abscesses only 35% were identified at presentation. Urine cultures were positive in 72% of patients and CT had a diagnostic sensitivity of 92%. Ten patients with a mean abscess size of 1.8 cm. were treated with antibiotics alone (mean hospitalization 10 days) while 11 with a mean abscess size of 11 cm. received antibiotics and initial percutaneous drainage (mean hospitalization 30 days). Of the 11 patients treated with percutaneous drainage 4 ultimately required surgical exploration and nephrectomy. CONCLUSIONS: The clinical characteristics of perinephric abscesses have not changed significantly but improved imaging with CT allows earlier diagnosis and treatment, which likely contributed to the reduced mortality in our cohort compared to historical series. With accurate staging and careful followup, a variety of treatments can be successful, including antibiotics alone or in conjunction with percutaneous drainage and urinary drainage. Open surgical drainage and nephrectomy may eventually be required in some patients and should be considered if adequate drainage is not achieved.
Assuntos
Abscesso/cirurgia , Antibacterianos , Drenagem , Quimioterapia Combinada/uso terapêutico , Nefrectomia , Perinefrite/cirurgia , Abscesso/diagnóstico , Abscesso/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Perinefrite/diagnóstico , Perinefrite/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do Tratamento , UltrassonografiaRESUMO
Urinary infection is very common in women. Generally no imaging is needed. The role of imaging is mandatory in the following cases: renal infection, urinary obstructive syndrome, immuno-compromised patients. The results of imaging in pathology are described: pyelonephritis, renal and perinephric abscesses with or without phlegmon, perinephritis and emphysematous perinephritis. A strategy for imaging procedures is proposed.
Assuntos
Diagnóstico por Imagem/métodos , Infecções Urinárias/diagnóstico , Abscesso/diagnóstico , Doença Aguda , Adulto , Celulite (Flegmão)/diagnóstico , Enfisema/diagnóstico , Feminino , Humanos , Nefropatias/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Perinefrite/diagnóstico , Pielonefrite/diagnóstico , Fatores Sexuais , Tomografia Computadorizada por Raios X , Ultrassonografia , Obstrução Uretral/diagnósticoRESUMO
A case of isolated bilateral xanthogranulomatous perinephritis, which presented as a symmetrical irregular perirenal rim of soft tissue, is reported. Differential diagnosis and image features on ultrasound, computed tomography, and magnetic resonance are discussed.
Assuntos
Granuloma/diagnóstico , Perinefrite/diagnóstico , Xantomatose/diagnóstico , Diagnóstico Diferencial , Granuloma/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Perinefrite/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia , Xantomatose/diagnóstico por imagemRESUMO
Undetected and untreated renal and perinephritic abcesses are associated with high morbidity and mortality rates. Thanks to the technique of ultrasonography and computed tomography, it is now possible to identify a suspected abscess early on. As treatment, percutaneous drainage has proved both effective and associated with only few side effects. Two cases are reported, one with renal, one with perinephritic abscess, both of which were successfully treated with percutaneous drainage.
Assuntos
Abscesso/terapia , Nefropatias/terapia , Perinefrite/terapia , Abscesso/diagnóstico , Adolescente , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/terapia , Diagnóstico por Imagem , Drenagem , Feminino , Humanos , Nefropatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea , Perinefrite/diagnóstico , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/terapiaRESUMO
Empyema of renal origin is very rare (3% in our series). We discuss 4 cases of empyemas associated to perirenal infection. Two of them were diabetic and all of them have renal lithiasis. They made their debut through pleural effusions, isolating Escherichia coli in all of them. Treatment was antibiotics and drainage in both foci, three of them evolved to healing and one of them died being the abdominal foci without drainage. This association must be suspected when no clear etiology of the empyema is present in patients with history of renal lithiasis and diabetes.
Assuntos
Empiema Pleural/diagnóstico , Infecções por Escherichia coli/diagnóstico , Perinefrite/diagnóstico , Infecções Estreptocócicas/diagnóstico , Adulto , Idoso , Nefropatias Diabéticas/complicações , Nefropatias Diabéticas/diagnóstico , Empiema Pleural/etiologia , Infecções por Escherichia coli/complicações , Feminino , Humanos , Cálculos Renais/complicações , Cálculos Renais/diagnóstico , Masculino , Pessoa de Meia-Idade , Perinefrite/complicações , Infecções Estreptocócicas/complicaçõesRESUMO
This study evaluates inter-author variability in knowledge base construction. Seven board-certified internists independently profiled "acute perinephric abscess", using as reference material a set of 109 peer-reviewed articles. Each participant created a list of findings associated with the disease, estimated the predictive value and sensitivity of each finding, and assessed the pertinence of each article for making each judgment. Agreement in finding selection was significantly different from chance: seven, six, and five participants selected the same finding 78.6, 9.8, and 1.6 times more often than predicted by chance. Findings with the highest sensitivity were most likely to be included by all participants. The selection of supporting evidence from the medical literature was significantly related to each physician's agreement with the majority. The study shows that, with appropriate guidance, physicians can reproducibly extract information from the medical literature, and thus established a foundation for multi-author knowledge base construction.
Assuntos
Inteligência Artificial , Coleta de Dados , Interpretação Estatística de Dados , Sistemas Inteligentes , Aplicações da Informática Médica , Abscesso/diagnóstico , Humanos , Medicina Interna , Registro Médico Coordenado , Perinefrite/diagnósticoRESUMO
In spite of technical advances in diagnostic radiology the recognition of a perinephric abscess is still a challenge to even the most experienced urologist. Untreated perinephric abscesses result in considerable mortality. We present ten years experience from 17 patients. All underwent open drainage procedures. In our case this still seems to be the treatment of choice for the majority of these patients. Percutaneous drainage is an alternative to surgery, and is particularly suitable for the high risk patient.