Perinephric Abscess Research Articles

PERINEPHRIC ABSCESS MASQUERADING AS AN ANGIOMYOLIPOMA

No AccessJournal of UrologyClinical Urology: Case Reports1 Feb 1998PERINEPHRIC ABSCESS MASQUERADING AS AN ANGIOMYOLIPOMA Geoffrey J. Bisignani, Lara A. Hardesty, David S. Hartman, and Mark V. Jarowenko Geoffrey J. BisignaniGeoffrey J. Bisignani More articles by this author , Lara A. HardestyLara A. Hardesty More articles by this author , David S. HartmanDavid S. Hartman More articles by this author , and Mark V. JarowenkoMark V. Jarowenko More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)63961-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "PERINEPHRIC ABSCESS MASQUERADING AS AN ANGIOMYOLIPOMA." The Journal of Urology, 159(2), p. 500 References 1 : CT diagnosis of renal angiomyolipoma: the importance of detecting small amounts of fat.. AJR.1988; 151: 497. Google Scholar 2 : Fat density in renal cell carcinoma: demonstration with computer tomography.. J. Urol.1997; 157: 1347. Link, Google Scholar 3 : Fat containing renal mass in childhood: a case report of teratoid Wilms tumor.. J. Urol.1994; 151: 1662. Link, Google Scholar Division of Urology and Department of Radiology, Pennsylvania State University, College of Medicine, Milton S. Hershey Medical Center, University Hospital, Children's Hospital, Hershey, Pennsylvania.© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 159Issue 2February 1998Page: 500 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information Geoffrey J. Bisignani More articles by this author Lara A. Hardesty More articles by this author David S. Hartman More articles by this author Mark V. Jarowenko More articles by this author Expand All Advertisement PDF downloadLoading ...

Conservative management with percutaneous intervention of major blunt renal injuries

This retrospective study assessed the results of treatment of patients with renal trauma to determine the optimal management (conservative or surgical) for patients with grade III renal injuries. During the past 12 years 108 patients (including 43 children) with renal injuries were managed: 43 had grade I injuries (renal contusion), 33 had grade II (minor laceration), 31 had grade III (major laceration), and 1 had grade IV (pedicle injury). All patients with grades I and II injuries were successfully managed conservatively. The patient with renal pedicle injury underwent uneventful nephrectomy. Nineteen patients with grade III injuries (including 5 patients with shattered kidneys and 3 patients with polar avulsion) were managed conservatively, and 2 developed progressively enlarging urinomas that required percutaneous drainage with complete resolution. No patient in this group developed perinephric abscess or urinary fistulae, and no delayed nephrectomy was necessary. Long-term follow-up of 7 patients in this group, including 3 with shattered kidneys and 2 with polar avulsion, showed that none have developed hypertension. Twelve patients with grade III injuries were managed surgically. Six (50%) patients underwent total (4 patients) or partial (2 patients) nephrectomy. In 6 patients, the surgical intervention was only open drainage of the perinephric collection and/or parenchymal suturing. It was concluded that conservative management with timely percutaneous or endoscopic intervention in patients with major renal injuries results in minimal loss of renal tissue without significant late complications.

RENAL AND PERIRENAL ABSCESSES

Our knowledge of the spectrum of renal abscesses has evolved as a result of more sensitive radiologic techniques. The classification of intrarenal abscesses currently includes acute focal bacterial nephritis, acute multifocal bacterial nephritis, renal cortical abscess, renal corticomedullary abscess, and xanthogranulomatous pyelonephritis. The clinical presentation of these entities does not differentiate them, however, and various radiographic studies are helpful in making the diagnosis. The intrarenal abscess is usually treated successfully with antibiotic therapy alone. Antistaphylococcal therapy is indicated for the renal cortical abscess, whereas therapy directed against the common gram-negative uropathogens is indicated for most of the other entities. The perinephric abscess is often an elusive diagnosis, has a more serious prognosis, and is more difficult to treat. Drainage of the abscess and sometimes partial or complete nephrectomy, in addition to antibiotic therapy, are required for resolution.

Acute Appendicitis Presenting as a Perinephric Abscess

D. S., a 59-year-old man with diabetes mellitus type I1 and hypertension, presented with diffuse abdominal pain, fever and chills 2 weeks in duration. He denied other gastrointestinal or urological complaints. Physical examination demonstrated fever of 102F, and a nonacute abdomen with minimal tenderness in the right upper quadrant and right flank. Laboratory evaluation revealed a white blood count of 11,900/mm.3 (normal 4,800 to 10,800) and urinalysis with no hematuria. The patient was hospitalized for intravenous antibiotics and hydration. Computerized tomography showed a right perinephric abscess with perirenal gas (see figure). The abscess was drained via a right flank incision and necrotic portions of Gerota’s fascia were removed. The perinephric abscess did not extend into the peritoneal cavity and the kidney appeared otherwise normal. Two days postoperatively intraoperative cultures yielded Escherichia coli, En-

Acute Appendicitis Presenting as a Perinephric Abscess

Acute Appendicitis Presenting as a Perinephric Abscess

ACUTE RENAL INFECTIONS

Most adults with uncomplicated acute pyelonephritis pose no diagnostic or therapeutic problems and recover fully. When imaging is requested in these cases, CT scan with and without contrast enhancement is preferable; however, depending on the condition of the patient and preference of the clinician an IVU, sonogram, or radionuclide scan may also provide adequate information. Patients at higher risk for complications, such as renal or perinephric abscesses with or without PHN and EPN, require aggressive and vigorous clinical and radiologic monitoring. CT scan is superior to other imaging modalities in the investigation of these complications. Interventional percutaneous procedures are established as safe and effective means of controlling or curing the infection in many patients and are often chosen over traditional surgical technique. The radiologist thus is an indispensable member of the management team and should be available for consultation and intervention.

Abcès périrénal à Candida glabrata: description d'un cas et revue de la littérature

Summary Among fungal infections in immunocompromised patients, the incidence of Candida glabrata has been dramatically increasing over the past decade, mainly in patients with solid tumour. Although development of perinephric abscess associated with C. glabrata has been reported in few cases, the authors describe an observation in which bulky abscess was diagnosed with CT scan and needle aspiration. The authors emphasise the difficulties of anti-fungal therapy in invasive C. glabrata infections.

Management of Combined Renal and Pancreatic Trauma

During a 15-year period we treated 38 patients with combined renal and pancreatic injuries (40 kidneys): 18 patients (19 kidneys) with renal contusion (89% from blunt trauma) and 20 with renal laceration or vascular injuries (90% from penetrating trauma). All patients with renal contusion were managed conservatively without complication, despite major pancreatic injury in a third. The 16 patients with significant renal and pancreatic injuries were classified as a high risk group: 3 underwent nephrectomy for vascular injuries that could not be repaired but all of the remaining kidneys were salvaged. Perinephric abscesses developed in 2 of these patients, for a major complication rate of 15%. No secondary nephrectomies were necessary, nor did urinary fistulas develop. We conclude that significant renal injuries in patients with major pancreatic injuries may be managed by renal repair with an increased but acceptable complication rate and that nephrectomy should be performed only if the degree of renal injury precludes repair.

The Role of Anaerobic Bacteria in Perinephric and Renal Abscesses in Children

To investigate the aerobic and anaerobic microbiology of renal abscesses in children. Aspirates from six children with perinephric and four with renal abscess were cultured for aerobic and anaerobic bacteria. A total of 20 organisms were recovered, 8 aerobic or facultative bacteria and 12 anaerobic bacteria. Aerobic or facultative bacteria only were recovered in one patient, anaerobic bacteria only in two, and mixed aerobic and anaerobic bacteria in seven. Anaerobic bacteria were isolated in perinephric abscesses that were associated with previous abdominal surgery and renal transplant and in renal abscesses that were related to malignancy, pyelonephritis, and orodental infection. This study highlights the importance of anaerobic bacteria in perinephric and renal abscesses in children.

Nocardial psoas and perinephric abscess in a renal transplant treated by surgery and antibiotics

Nocardial psoas and perinephric abscess in a renal transplant treated by surgery and antibiotics

Dome-Shaped Lesion on Chest Radiograph

A 50-year-old man with an 8 x 4 cm mass on the posterior chest was found to have a large retroperitoneal abscess due to Klebsiella pneumoniae. The abscess dissected through the right lower lobe of the lung and the posterior chest wall to produce a subcutaneous mass. The source of the posterior chest wall mass appeared to be a perinephric abscess. A dome-shaped lesion above the right hemidiaphragm on chest radiograph resolved immediately with surgical drainage, suggesting that an abscess should be a prime consideration when one observes such a lesion on a chest film.

Major Renal Lacerations with a Devitalized Fragment following Blunt Abdominal Trauma: A Comparison between Nonoperative (Expectant) Versus Surgical Management

Of 43 patients who sustained blunt trauma resulting in a major renal laceration with a devitalized fragment 27 had coexisting intraperitoneal and renal injuries for which emergency celiotomy and repair of the nonurological trauma were done. Management of the renal injuries consisted of simultaneous renal exploration with 23% urological morbidity in 13 cases or expectant management with 85% urological morbidity in 14 cases. In this latter patient population infected urinomas and perinephric abscesses seeded from coexisting enteric or pancreatic injuries were the most common complication (57%). The remaining 16 of the 43 patients sustained renal lacerations without associated intraperitoneal injuries and all were managed expectantly with 38% urological morbidity. These findings suggest that renal exploration and surgical repair significantly improve the prognosis only in patients with simultaneous intraperitoneal and renal injuries (p < 0.01).

Perinephric Abscess Due to a Coagulase-Negative Staphylococcus: Case Report and Review of the Literature

Perinephric abscess is an uncommon urinary tract infection that usually is caused by Staphylococcus aureus as a single pathogen or gram-negative bacilli as part of a polymicrobial process. We describe a man who presented with a right perinephric abscess due to coagulase-negative Staphylococcus as the only pathogen. The patient had bilateral nephrolithiasis, and he was treated successfully with percutaneous drainage of the abscess and parenteral antibiotics. Coagulase-negative staphylococci are increasingly reported to cause serious infections. This organism can no longer be routinely dismissed as a contaminant or colonizer. Repeated isolation of coagulase-negative Staphylococcus in the absence of other pathogens must be considered a high risk situation.

Evaluating Consensus Among Physicians in Medical Knowledge Base Construction

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.

Yeast Perinephric Abscess: Report of a Case and Review

We report a case of yeast perinephric abscess and review 11 other published cases. This rare entity occurs primarily in patients who have diabetes mellitus, who have recently undergone surgery, or who have urinary tract obstruction. The clinical illness is often subacute or chronic with nonspecific symptoms. Candida and Torulopsis species are the reported etiologic agents. Successful therapy usually consists of percutaneous or surgical drainage of the abscess. Overall mortality is 25%; however, no patient in this series died as a direct result of perinephric infection.

Late Perinephric Abscess Formation after Extracorporeal Shock Wave Lithotripsy

British Journal of UrologyVolume 68, Issue 3 p. 323-324 Late Perinephric Abscess Formation after Extracorporeal Shock Wave Lithotripsy W. KOCHAKARN, W. KOCHAKARN Division of Urology, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandSearch for more papers by this authorK. RATANA-OLARN, Corresponding Author K. RATANA-OLARN Division of Urology, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandDepartment of Surgery, Ramathibodi Hospital, Rama 6 Road, Bangkok 10400, Thailand.Search for more papers by this author W. KOCHAKARN, W. KOCHAKARN Division of Urology, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandSearch for more papers by this authorK. RATANA-OLARN, Corresponding Author K. RATANA-OLARN Division of Urology, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandDepartment of Surgery, Ramathibodi Hospital, Rama 6 Road, Bangkok 10400, Thailand.Search for more papers by this author First published: September 1991 https://doi.org/10.1111/j.1464-410X.1991.tb15337.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume68, Issue3September 1991Pages 323-324 RelatedInformation

Klebsiella pneumoniae Urinary Tract Infection Complicated by Endophthalmitis, Perinephric Abscess, and Ecthyma Gangrenosum

We have reported the case of an immunocompromised patient with a K pneumoniae bacteremia admitted with endophthalmitis. The source of the infection was an asymptomatic left renal calculus associated with a perinephric abscess. Persistent bacteremia resulted in the development of ecthyma gangrenosum, which has not previously been associated with Klebsiella spp infection.

Clinical radiological management of an uncommon perinephric abscess

The authors describe an uncommon case of a huge perinephric abscess with a gas-fluid level occupying the upper left abdomen. A rational sequence of radiological diagnostic methods such as plain film, ultrasound, CT, and combined retrograde urogram with contrast filling of percutaneous drainage led to correct management.

Perinephric inflammatory process following extracorporeal shock wave lithotripsy

A patient with large branched staghorn calculi was treated with ESWL. She suffered from recurrent urinary tract infections. Following ESWL she developed a perinephric abscess, which necessitated percutaneous drainage. The clinical course is described and a possible pathogenesis of perinephric abscess following ESWL is suggested.

Perinephric Abscesses: Percutaneous Versus Open Surgical Drainage

Perinephric abscess in the past was associated with high morbidity and mortality rates. Standard therapy has included antibiotics and open surgical drainage. The advent of sonography and computed tomography has facilitated the diagnosis and treatment via percutaneous drainage. A retrospective search yielded 16 cases of perinephric abscesses at our institution between January 1980 and January 1990. Each case was evaluated with regard to age, sex, predisposing factors, diagnostic tests, treatment modality, morbidity and mortality. Seven patients underwent percutaneous drainage by either a Seldinger or trocar catheter techique. Six of these had successful drainage. The one unsuccessful case was a patient with an infected hematoma, which was treated successfully with open surgical drainage. Nine patients initially underwent open surgical drainage. Five also had nephrectomies for renal scan-documented nonfunctioning kidneys that contained renal caluli. Of the remaining four patients, one had a staghorn calculu...