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 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Perinephric abscess is a life-threatening but treatable process. Most infections of the perinephric space occur as a result of extension of an ascending urinary tract infection, commonly in association with nephrolithiasis or urinary tract obstruction. A large portion of the mortality is the result of failure to diagnose this entity in a timely fashion. This failure may be because of the frequently obscure or nonspecific nature of the clinical presentation. Blood cultures as well as urine cultures may fail to identify correctly the bacterial pathogens responsible for the abscess. Perinephric abscess should be considered in the differential diagnosis of any patient presenting with a urinary tract infection that fails to respond promptly to antibiotic therapy, particularly in those known to have anatomical abnormalities of the urinary tract or diabetes mellitus. Consideration of this diagnosis should enter into the differential diagnosis of fever with abdominal pain or flank pain. Early recognition of perinephric abscess and prompt drainage, either percutaneously or surgically, in combination with appropriate antibiotic coverage, should reduce dramatically the morbidity and mortality from this infection.
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PMID:Perinephric abscess: the missed diagnosis. 304 58

Emphysematous pyelonephritis is a severe infection characterized by the presence of gas within the renal parenchyma and perirenal tissues. Two cases of this disease are presented. They were the 16th and 17th case reported in Japan. Case 1 was a 63-year-old woman with diabetes mellitus and liver cirrhosis. She was hospitalized for abdominal pain and anuria. Renal X-rays showed a gas shadow in and around the left kidney, but no evidence of upper urinary tract obstruction. Although hemodialysis was done, she died of heart failure. Case 2 was a 54-year-old man with diabetes mellitus was admitted with the complaint of fever and left abdominal pain. Renal X-rays showed a gas shadow in and around the left kidney but no evidence of upper urinary tract obstruction. He was treated with intensive antibiotic therapy, control of blood sugar, intravenous drips and percutaneous drainage. Clinical features improved, but deteriorated after 40 days of therapy. The gas shadow remained unchanged on CT scanning, and aortography showed the occlusion of the left renal artery. Nephrectomy was done after 50 days. Seventeen cases of emphysematous pyelonephritis in the literature including our cases are reviewed, especially the choice of the treatment is discussed.
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PMID:[Two cases of emphysematous pyelonephritis--considerations on the choice of treatment]. 359 89

Congenital ureteropelvic junction obstruction is the most common site of urinary tract obstruction in children. In infants an abdominal mass, in older children loin or abdominal pain, especially after fluid intake, are commonly the presenting features. In some cases the only symptom is posttraumatic hematuria. Appropriate diagnostic procedures are suggested.
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PMID:[Masked obstructive uropathy of the upper urinary tract in childhood]. 390 76

Eighteen men presenting with metastatic germ-cell malignancy in whom no primary tumour could be palpated in either testis are described. All patients had both testes in the scrotal sac and none had a history of maldescent. All had abdominal node involvement, in most cases associated with metastases at other sites. Ten men presented with Stage 4 disease, five with Stage 3 and three with Stage 2. The most common histological sub-type associated with an occult primary testicular tumour was trophoblastic malignant teratoma (9/18 patients). Abdominal pain (12 patients) and systemic symptoms (10 patients) were common presenting features. There was a history of testicular atrophy in eight patients and seven had experienced episodes of transient testicular pain up to 18 months before presentation. In three of four patients in whom the testis was examined histologically following a history of atrophy and/or pain, there was evidence of a primary tumour, manifest as spontaneous tumour regression (one), differentiation (one) or a small micro-primary trophoblastic teratoma (one). In a fifth patient an ultrasonic scan showed a 1-cm echogenic mass in an atrophic testis. In 10 patients the diagnosis of germ-cell malignancy was established by laparotomy. Obstructive uropathy was present in six patients, associated with haematuria in four patients.
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PMID:Occult germ-cell testicular tumours. 688 52

Genital prolapse is common among ageing women. Urinary obstruction and hydronephrosis have been reported as one of the most severe and fortunately uncommon complications. An 82-year-old multiparous woman with symptomatic pelvic organ prolapse quantification stage 4 genital procidentia fails multiple trials of pessary and abandons the trials due to significant side effects. She chooses to pursue conservative management with estrogen cream and tight underwear. However, she fails to follow up as planned. Two years later, she presents with acute abdomen and renal failure due to renal calyceal rupture and perirenal urinary extravasation from complete procidentia. She is treated promptly with urinary catheter, manual prolapse reduction, and Gellhorn pessary which relieves anuria and stabilizes her condition. She then receives definitive surgical treatment 2 weeks later. Her renal failure and abdominal pain resolve post-operatively.
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PMID:Renal calyceal rupture and perirenal urinary extravasation from complete procidentia. 2134 31

Xanthogranulomatous pyelonephritis is an uncommon chronic destructive granulomatous process of renal parenchyma in association with long-term urinary tract obstruction and infection. It affects females more often than males, with a wide range of age, from newborn to elderly. Almost all patients are symptomatic and the most common symptoms are flank or abdominal pain, lower urinary tract symptoms, fever, palpable mass, gross hematuria, and weight loss. The common laboratory findings are leukocytosis and anemia. Urine cultures most often reveal Escherichia coli and Proteus mirabilis . Computed tomography is the mainstay of diagnostic imaging for xanthogranulomatous pyelonephritis. Imaging studies may demonstrate diffuse or focal form. Histologically, xanthogranulomatous pyelonephritis presents a granulomatous inflammatory infiltrate composed of neutrophils, lymphocytes, plasma cells, xanthomatous histiocytes, and multinucleated giant cells. The differential diagnosis includes clear cell renal cell carcinoma, papillary renal cell carcinoma, sarcomatoid renal cell carcinoma, leiomyosarcoma, malakoplakia, and megalocytic interstitial nephritis. Both antibiotics and surgery can be treatment options depending on the patient's disease status.
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PMID:Xanthogranulomatous pyelonephritis. 2152 66

We report the atypical case of a nondiabetic 66-year old male with severe abdominal pain and vomiting who was found to have emphysematous cystitis. Of all gas-forming infections of the urinary tract emphysematous cystitis is the most common and the least severe. The major risk factors are diabetes mellitus and urinary tract obstruction. Most frequent causative pathogens are Escherichia coli and Klebsiella pneumoniae. The clinical presentation is nonspecific and ranges from asymptomatic urinary tract infection to urosepsis and septic shock. The diagnosis is made by abdominal imaging. Treatment consists of broad-spectrum antibiotics, bladder drainage, and management of the risk factors. Surgery is reserved for severe cases. Overall mortality rate of emphysematous cystitis is 7%. Immediate diagnosis and treatment is necessary because of the rapid progression to bladder necrosis, emphysematous pyelonephritis, urosepsis, and possibly fatal evolution.
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PMID:Emphysematous cystitis: report of an atypical case. 2260 8

Emphysematous pyelonephritis is a severe, potentially fatal necrotizing pyelonephritis with a variable clinical presentation, ranging from mild abdominal pain to septic shock. The majority of cases occur in diabetics with poor glycemic control, while a small percentage may be due to urinary tract obstruction. We present a case of a 57 year old male patient, diabetic on treatment, presenting with left flank pain and poor stream of urine since one week. Laboratory tests revealed that the patient had electrolyte imbalance, ketoacidosis and high blood sugar. Urine culture was positive for Escherichia coli with a signifi cant colony count. Radiological examination gave a diagnosis of Left Type 1 Emphysematous Pyelonephritis. Inspite of giving vigorous resuscitation and antibiotics with nephrostomy, the patient had to undergo nephrectomy due to extensive renal parenchymal destruction. The nephrectomy specimen was studied in detail to know the histopathological findings in a case of diabetic patient with emphysematous pyelonephritis. We present this case not only because of it being a rare complication of diabetes, but also to focus on the histopathological findings of the same, documentation of which is limited in literature.
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PMID:Emphysematous pyelonephritis in a diabetic leading to renal destruction: pathological aspects of a rare case. 2381 3

Acute life-threatening conditions in oncology patients may develop either because of underlying malignancy or as a complication from treatment. Oncologic emergencies can be categorized as metabolic, hematologic, and structural conditions. Metabolic and hematologic emergencies are mainly diagnosed on the basis of clinical and laboratory findings. Structural pathologic conditions that result in bleeding, mechanical compression, or obstruction to the hollow organs, such as the trachea and bowel loops, may first be suspected because of clinical findings, including decreasing hematocrit levels, difficulty in breathing, and abdominal pain; however, performance of imaging studies is critical for timely diagnosis and management. Life-threatening conditions of the central nervous system (such as cerebral herniation, carcinomatous meningitis, and spinal cord compression), thoracic emergent conditions (such as central airway obstruction, esophagorespiratory fistula, massive hemoptysis, pulmonary embolism, superior vena cava syndrome, and pericardial tamponade), and abdominopelvic emergencies (such as uncontrolled intraabdominal hemorrhage, bowel obstruction, intestinal perforation, bowel ischemia, intussusception, and urinary tract obstruction) can be definitively diagnosed on the basis of projectional or cross-sectional imaging findings in appropriate clinical scenarios. Select emergent conditions in cancer patients related to chemotherapy and radiation treatment, as well as iatrogenic emergencies secondary to either surgery or placement of central venous catheters, may also demonstrate characteristic findings at imaging studies. In addition, interventional procedures are of great help in the treatment of acute superior vena cava syndrome, massive hemoptysis, and uncontrolled intraabdominal hemorrhage. Radiologists should be aware of these select, "not to be missed" imaging findings of oncologic emergencies to make an accurate, timely diagnosis and provide appropriate patient care.
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PMID:Imaging of oncologic emergencies: what every radiologist should know. 2410 50

Crossed renal ectopia is a rare urinary system anomaly which mostly is asymptomatic and is diagnosed incidentally. Urinary obstruction, infection, and neoplasia of the urinary system and nephrolithiasis are main complications of this anomaly. A 6-year-old boy admitted to the hospital with colicky abdominal pain and nausea. Abdominal examination revealed tenderness in right lower quadrant. Urine analysis and culture were normal. Kidney ultrasonography showed right kidney in pelvis cavity with no kidney tissue in left side. TC 99-DMSA scan demonstrated no radiotracer accumulation in the normal renal area. Radiotracer accumulation was seen in the pelvis area with a deviation to the left. Voiding cystoureterogram revealed right sided grade II vesicoureteral reflux. Severe urological anomalies in children may be asymptomatic or have nonspecific symptoms such as abdominal pain.
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PMID:Cross-fused renal ectopia associated with vesicoureteral reflux; a case report. 2768 23


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