Perinephric Abscess Research Articles

Perinephric Abscess in Patients with Polycystic Kidney Disease Undergoing Chronic Hemodialysis

5 patients with polycystic kidney disease undergoing chronic hemodialysis who developed perinephric abscesses are described. Gallium-67 scintigraphy was helpful in making a diagnosis in 2 of these patients. All 5 patients initially presented with urinary tract infections. Perinephric abscess became evident over a variable period of time (2--28 days) following completion of antibiotic therapy for their urinary tract infection. Gallium-67 scintigraphy appears useful in detecting this complication, and nephrectomy should be considered once the diagnosis is confirmed.

Gallium-67 imaging in abdominal disease

Gallium-67 imaging is useful for detecting sites of intra-abdominal inflammation, including subphrenic abscesses, postoperative infection, pyelonephritis or perinephric abscesses, and peritonitis. Positive images may be obtained within several hours of injection, but are more reliable at 24 hr. The results may be used to guide ultrasound or computed tomography studies, which give a detailed anatomic picture of the abscess. Gallium-67 imaging has also been used to detect abdominal neoplasms, but results are less impressive. Abdominal lymphoma is detected in just over 50% of sites. Gastrointestinal, renal, and gynecologic neoplasms are detected even less frequently. However, 67Ga is useful for detecting recurrence of 67Ga-avid neoplasms, and has been reliable in detecting hepatomas and nodal spread of seminoma. When used selectively in patients with neoplastic disease and suspected abscesses, 67Ga is an effective method for diagnosing abdominal disease.

Case profile: selective arteriography in perinephric abscess

Case profile: selective arteriography in perinephric abscess

Perinephric Abscess: A Review of 26 Cases

Herein we review 26 cases of perinephric abscess, analyzed according to incidence, etiology, laboratory findings, signs and symptoms, diagnosis, radiographic findings, operative procedures, mortality and associated diseases. Of the abscess cultures 67 per cent were gram-negative organisms, most commonly Proteus, and 76 per cent of the abscesses were directly attributable to renal causes, mainly nephrolithiasis. Diabetes mellitus occurred in only 3 of the 26 cases.

Case 41-1977

Presentation of CaseA 68-year-old man was admitted to the hospital because of dehydration.There was a long history of peripheral vascular disease. Fifteen years before entry bleeding occurred from a peptic ulcer. Eight years later a right nephrectomy was performed at another hospital because of a perinephric abscess. Six years before admission ischemic ulcers appeared on the right foot. He was admitted to this hospital, where aortoiliac occlusion was found, and a Dacron aortofemoral bypass graft was inserted. Two months later, becase of persistent pain and ischemic ulcers on the right foot, a right-saphenous-vein femoral-popliteal bypass graft was performed. . . .

Non-Invasive Localization of Urinary Tract Infection

New methods to localize the source of bacteriuria were evaluated in monkeys with experimental urinary tract infection. A high level of diagnostic accuracy was obtained with the combined study of antibody-coated urinary bacteria by immunofluorescence, 131I hippuran scintiphotos in the hydropenic state and 67gallium citrate scintiphotos. Unique patterns were found, which differentiate cystitis, ureteritis, pyelonephritis and renal or perinephric abscesses.

Perinephric abscess aspiration using ultrasound guidance

A perinephric is difficult to diagnose by clinical examination and traditional radiographic imaging techniques. Five cases are described in which the sonograms revealed a sonolucent perinephric collection suggestive of perinephric abscess. Diagnostic percutaneous aspiration performed under ultrasound guidance is a rapid, reliable, and safe means of distinguishing an abscess from a noninflammatory collection.

Renal and Perirenal Gas in a Diabetic Man

<h3>History</h3> A 64-year-old diabetic man experienced back pain, fever, chills, and dyspnea for one week. On examination, his rectal temperature was 38 C; pulse rate, 120 beats per minute; and respiratory rate, 30/min. He had distended neck veins, a ventricular gallop, dullness to percussion at the base of each lung, peripheral edema, and tenderness in his right flank. Total leukocyte count was 19,900/cu mm; blood glucose concentration, 319 mg/100 ml; and BUN level, 88 mg/100 ml. Urine gave a 1 + glucose reaction and contained 70 to 100 WBCs and numerous bacilli per high power field. Cultures of blood and urine grew<i>Escherichia coli</i>. Roentgenographic studies include a chest film (Fig 1) and anteroposterior and lateral abdominal films (Fig 2 and 3). <h3>Diagnosis</h3> Emphysematous pyelonephritis with perinephric abscess and emphysematous cystitis. <h3>Comment</h3> The chest film depicts pulmonary vascular congestion, bilateral pleural effusions, infiltrates in both lower lobes, and gas partially outlining

Sonographic-radiographic correlations of renal and perirenal infections.

Sonograms of 43 patients with intrinsic and perirenal infectious processes are reviewed. Fourteen had acute pyelonephritis; three, suppurative pyelonephritis; two, focal pyelonephritis; six, renal abscesses; three, infected cysts; six, perinephric abscesses; six, pyonephrosis; and three, chronic pyelonephritis. Sonography had little diagnostic value except for the patients with perinephric abscess. However, it proved valuable as a guide for a percutaneous approach to obtain cells for histologic diagnosis, to obtain fluid to determine chemotherapy, and to perform antegrade pyelography and percutaneous nephrostomy.

Uroradiology of diabetes mellitus

Diabetes mellitus is a prevalent disorder, well controlled in many persons with prolongation of life. Several radiologic manifestations are sufficiently specific to suggest a diagnosis in the unidentified patient, but even more important is an awareness of the sometimes life-threatening complications of diabetes which can be diagnosed from uroradiologic studies. We review the following urinary tract manifestations and complications of diabetes: pyelonephritis, perinephric abscess, renal papillary necrosis, emphysematous pyelonephritis, emphysematous cystitis, fungus infections, calcification of the vas deferens, seminal vesicle, and intrarenal branches of the renal artery, neuropathic bladder, and renal failure.

Significance of Circulating Capsular Antigen in Klebsiella Infections

Klebsiella capsular antigen (KCA) was detected in serum by counterimmunoelectrophoresis in 8 of 31 patients with klebsiella bacteremia, in two nonbacteremic patients with pneumonia and meningitis, respectively, and in the cerebrospinal fluid only of 1 of the 31 bacteremic patients. It was also detected in cerebrospinal fluid, urine (two patients each) empyema fluid, and abscess drainage (one patient each). Patients whose bacteremias were associated with a discernible tissue focus (e.g., pneumonia) tended to have detectable serum KCA more often than those with "primary bacteremia." A fatal outcome occurred in six of nine bacteremia patients with detectable serum KCA compared with 4 of 22 without demonstrable antigen (P < 0.05). Persistent antigenemia and antigenuria aided in the diagnosis of perinephric abscess in one patient, and increasing levels of serum KCA anticipated treatment failure in another patient with pneumonia. The presence of detectable KCA in the serum of patients infected with klebsiella thus appeared to correlate with severity of infection, with persistence of active foci, and with a poorer prognosis than in those patients who had no detectable antigen. Whether the presence of this antigen itself plays any pathogenic role needs to be further clarified.

Mycotic aneurysms in transplant patients.

Eight cases of mycotic aneurysm occurred in seven transplant patients. Perinephric wound infection involving the iliac arteries was the cause of at least seven aneurysms. Simple ligation of the iliac artery proximal and distal to the aneurysm without grafting was effective therapy in all but one patient with an aortic aneurysm who required an axillofemoral bypass graft prior to excision of the aneurysm. There were no instances of ischemia to the involved extremities, and only two patients died as a result of the aneurysm. This dangerous complication can be avoided by preventing wound infections. In established perinephric abscesses, the kidney should be removed and the wound kept as clean as possible in order to prevent this complication. Arteriograms may be useful in the early detection of these aneurysms, before they rupture.

Gallium-67 Scintigraphy for the Diagnosis and Localization of Perinephric Abscesses

AbstractFour patients with suspected perinephric abscess were evaluated by gallium-67 scintigraphy. Gallium-67 scintigraphs proved instrumental in correctly diagnosing and localizing 4 left perinephric abscesses. Roentgenographic examinations were negative in 2 cases. Gallium-67 scintigraphy can be a useful non-invasive technique to evaluate patients with suspected perinephric abscess.

A Case of Renal Papillary Necrosis and Perinephric Abscess associated with Diabetes Mellitus

A Case of Renal Papillary Necrosis and Perinephric Abscess associated with Diabetes Mellitus

The Place of Diagnostic Ultrasound in the Examination of Kidneys Not Seen on Excretory Urography

An examination was done on 28 patients with renal failure, 20 with unilateral hydronephrosis, 8 with multicystic kidneys, 3 with hypoplastic or chronically infected kidneys, and single examples of renal vein thrombosis, renal artery occlusion, xanthogranulomatous pyonephrosis with perinephric abscess, trauma and tumor invading the whole kidney. The distinct ultrasonic appearances of the various conditions causing radiographic non-visualization of the kidney are described.

Renal angiomyolipoma in adult-type polycystic disease

Two adults with renal angiomyolipomas and polycystic disease are presented with emphasis on the angiographic manifestations of the coexisting lesions. One patient had multiple episodes of gross hematuria and a perinephric abscess which resulted in bilateral nephrectomies; the second presented with hypertension and underwent unilateral nephrectomy to treat a hypervascular tumor. The clinical and radiographic diagnoses of the combined lesions are discussed and suggestions for management offered.

Detection and localization of intra-abdominal abscesses by diagnostic ultrasound.

In four patients, intra-abdominal abscesses were identified by ultrasonic technique: a right lower quadrant abscess in Crohn disease, a pyogenic liver abscess, a pelvic abscess following rejection and removal of a transplanted kidney, and a perinephric abscess. In all four the establishment by ultrasound that the mass was filled with fluid was critical in guiding drainage. Diagnostic ultrasound is a safe and effective means for the detection, localization, and characterization of retroperitoneal, intraperitoneal, or intraparenchymal inflammatory masses.

Opportunistic infections in colon carcinoma

Opportunistic infections due to protozoan or fungal agents do not occur in patients with colorectal carcinoma. Nevertheless these subjects may become infected with members of the normal bacterial flora of the gut which are provided with a site for penetration of the colonic mucosal barrier by the invasive or necrotizing tumor. Bacteroides sepsis, Clostridium septicum and other clostridial infections (in the absence of deep traumatic lesions), and left perinephric abscess caused by coliforms and fecal streptococci appear to be characteristic associations with colonic neoplasia. In the absence of a known colonic lesion, diagnostic workup should be performed in all such patients. Barium enema would similarly be indicated in older patients with bacterial endocarditis in whom the portal of entry of the organism was not known. Am. I. Clin. Nut,'. 27: 1481-1485, 1974. Carcinoma of the colon and rectum is a common malignancy of older patients with a peak incidence in the 7th decade of life. It accounts for about 1 5% of all deaths due to cancer, and is surpassed in this morbid statistic only by carcinoma of the lung. About 2.5% of all deaths in the United States are attributable to colorectal carcinoma alone. A significant proportion of these fatalities is related to infection (1) of which over 90% can be traced in turn to necrotic or ulcerated tumors, obstruction of the gut or urinary tract by large, compressing tumor masses, chemotherapy or radiation-induced mucosal lesions, perforation or peritonitis. Neutropenia is rarely a problem, in contrast to the situation prevailing in patients with leukemias or lymphomas. Over the past two decades, the concepts of the compromised host and the opportunistic pathogen have received prominence as increas- ing numbers of patients with ultimately fatal diseases survive for longer periods of time due to improved therapeutic modalities or life- support systems. These patients may thus live another day, but each day begins with the potential for a fatal encounter with ubiquitous microorganisms in the environment or members of the indigenous microbiota. Man normally lives in a state of delicate balance with a variety of microorganisms capable of provoking life- threatening illness if they can reach the right site in the body in sufficient numbers to overcome the multiplicity of defense mecha- nisms possessed by the host. Thus the host receiving immunosuppressive or cytotoxic chemotherapy, antibiotics which alter the qual- ity and/or quantity of this flora, in whom invasive disease processes or procedures breech intact surface barriers to penetration by micro- organisms, is compromised in his ability to resist infection. These significant alterations in the host predispose him to invasion by agents which normally live in close association with man as saprophytic commensal organisms. Because these generally noninvasive agents take advantage of the opportunity offered by a compromised host they have been called oppor- tunistic pathogens, and the diseases they cause,

Perinephric abscess.

Perinephric abscess.

Citrobacter perinephric abscess presenting as pneumoscrotum in transplant recipient

A case of Citrobacter diversus perinephric abscess presenting as pneumoscrotum in a transplant recipient is reported. Reference is made to the increasing incidence of the organism in clinical infection and its ability to produce gas within tissues. Pertinent clinical literature is briefly discussed.