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Infected Solitary Cyst of the Kidney in a Child, With a Review of the Literature
INFECTED SOLITARY CYST OF THE KIDNEY IN A CHILD, WITH A REVIEW OF THE LITERATURE THOMAS S. CHALKLEY
AND
LEE E. SUTTON, JR.
From the Department of Pediatrics at the Medical College of Virginia, Richmond
Large solitary renal cysts are rare in children. We have collected 10 cases from the literature and we are adding 1 of our own. However, only the case of Hawkins 1 was infected, and that one only after aspiration had been done. Davidson2 states that spontaneous infection of a solitary renal cyst is quite rare. He has been able to find but 5 cases reported in the literature and he adds 1 of his own. Of these cases, 5 were in adult females and 1 in an adult male. Fang3 adds a case in an adult female. CASE REPORT
A 11 year old colored girl admitted to the Medical College of Virginia Hospital September 6, 1942. The past history and family history were non-contributory. Three weeks previous to admission to the hospital she had a dull pain in the right upper quadrant of her abdomen. This continued steadily up to the time of admission to the hospital. The pain did not radiate and did not occur in relation to meals. She had had a dull headache most of this time. Forty-eight hours previous to admission she noticed a tender mass in the right upper quadrant. She had had 1 white bowel movement on September 5. There had been no nausea or vomiting and bowel movements had been regular. There were no urinary complaints. She was a well developed child for her age. There was a slight icteric tinge to the sclerae. The remainder of the positive physical findings were confined to the abdomen. There was a smooth, tender, deeply palpable, and slightly movable mass in the right upper quadrant. This was about 6 inches in diameter and seemed to extend about 4 finger-breadths below the costal margin just inside the nipple line. It seemed to be free from the liver, and was tender to palpation anteriorly but not particularly so posteriorly. There was no spasm of the recti. A tentative diagnosis of hypernephroma or hydronephrosis of the right kidney was made. Intravenous pyelograms (fig. 1) showed a normally functioning left kidney. The right kidney showed tapering of the calyces with the lower calyx displaced downward with an oval density, apparently cystic, spreading the middle and lower calyces apart and impinging upon the renal pelvis causing it to be markedly deformed. Roentgenological diagnosis was large right kidney tumor or cyst in the lower half of the right kid;ney. Repeated urinalyses showed 0 trace of albumin, and 0-20 white blood cells per high power field. The red blood count was 3,240,000 with 58 per pent hemo1 2 3
Hawkins, Caesar: Medico Chirurgical Rev., 20: 23-24, 1834. Davidson, B.: Infected renal cyst. N. Y. State, J. Med., 40: 875-881, 1940. Fang, C.H.: Solitary cyst of the kidney. Chin. Med. J., 53: 221, 1938. 414
SOLITARY CYST OF KIDNEY
415
globin. The white blood count was 6,000 with 81 per cent polymorphonuclears. The blood non-protein nitrogen was 40 with a total protein of 7.5 and an albumin-globulin ratio of 4.2/3.3. The icteric index was 7 and the cholesterol was 115. The child was seen in tumor clinic and since a diagnosis of malignant tumor was held likely, preoperative x-ray therapy was decided upon. She was given 1250 r units anteriorly and 1000 r to both the lateral and posterior portals. This was a total of 3250 r units in air. Due to the anemia she was given three transfusions preoperatively of 250 cc, 300 cc, and 150 cc.
FrG. 1. Intravenous urogram
On September 10 a cystoscopic examination was done. Attempts to pass a catheter into the right ureter were unsuccessful. This was followed in 2 days by the child having a temperature of 104 ° F and a pulse of 130. She was put on sulfathiazole for 24 hours. The temperature and pulse rapidly returned to normal. On September 29 a right nephrectomy was done by Dr. Austin Dodson. The kidney tissue appeared to be normal at the upper pole, but there was a tense cyst the size of a grape-fruit at the lower pole. This was opened and frank pus obtained. The kidney pelvis showed clear urine. She made an uneventful recovery and was discharged on the twentieth postoperative day.
416
THOMAS S. CHALKLEY AND LEE E. SUTTON, JR.
Dr. J. S. Howe stated that the specimen consisted of a right kidney containing a large incised cyst. The cyst measured 12 cm. in diameter, was thick walled, and was lined by a shaggy ivory colored material. No fluid was present in the cyst at the time the specimen was received. The kidney and pelvis had been incised, but no connection between the cyst and the pelvis was apparent. The calyces were dilated, but were lined with a smooth, glistening, mucosal surface as was the pelvis and ureter. The renal parenchyma, particularly over the cyst, was thin but revealed a well demarcated cortex and medulla. The arcuate arteries did not gap. Where the capsule of the kidney was still present, it could be stripped away with ease revealing a smooth surface. The upperpole of the organ was covered by typical adrenal cortex.
Fm. 2 Fm. 3 Fm. 2. Fibrous cyst wall showing epithelial remnants and chronic inflammatory granulation tissue. (X 115.) Fm. 3. Section showing normal epithelium of pelvis and portion of kidney tissue. (X 180.)
Upon microscopic examination, sections of the cyst wall were found to be composed of dense fibrous connective tissue lined on one surface with chronic inflammatory granulation tissue, with occasional fragments of preserved transitional epithelium (fig. 2). The epithelium lining the pelvis and calcyces was well preserved and showed no inflammatory reaction (fig. 3). One section of the kidney appeared essentially normal but had adhering to the cortex a small amount of adrenal cortex. Sections through the cyst wall and calyx showed no connection between the two although they were separated by only a small amount of kidney tissue. Pathological diagnosis was large solitary cyst of the kidney with suppuration, and moderate hydronephrosis. Culture of fluid from the cyst yielded Staphylococcus albus.
SOLITARY CYST OF KIDNEY
417
DISCUSSION
Hawkins described the first case in the literature in 1833. We have been able to find 9 other cases and to these we are adding one of our own making eleven cases in all, described in children. Wagner's 4 case in a 4½ year old boy has been included by some, but in reviewing his article he claims that there was a double pelvis and ureter on the right side; the upper pelvis and ureter having become hydronephrotic reaching the size of an infant's head. The case of Albarran and Imbert 5 in a 16 months old child has been omitted because there were 7 cysts in one kidney. Their belief was that they were a simple variety of a polycystic kidney. Zaccarini's 6 case in a 3 year old child has been omitted because the kidneys were of normal size, 1 containing a multilocular cyst the size of a hazelnut, and the other kidney a smaller one. Both were in the medulla and contained yellow fluid with blood. Bugbee and W ollstein 7 mention 2 cases of large serous cyst of the kidney occurring in children but no description is given except that in 1 case the opposite kidney was polycystic, and in the other case the opposite kidney presented diffuse nephritis. CASE REPORTS IN LITERATURE
Case 1. Six year old boy with history of being run over; pain and swelling in right side followed accompanied by fever. The tumor involved the entire right side of the abdomen. Two months later 18 ounces of nearly transparent clear fluid was aspirated. He died 2½ months later. The cyst contained 5 pints of the same type of fluid and in addition some white semi-purulent matter. The cyst was at the lower pole and had no communication to the pelvis. There was a third kidney the size of a walnut consisting of a single lobe with cortical and tubular part perfect and having a single mammillary process and calyx but no excretory duct extending from the kidney toward the inner part of the cyst. Case 2. 8 This child was 1 year old and had a large serous cyst resected with recovery following. Case 3. 9 This case was 1 year old and and had a cyst the size of a tangerine which was incised. 4 Wagner, Paul: Vier Operationen mit Eroffnung des Bauchfelles bei Kindern, Arch. f. klin. chir. 30: 517-519, 1884. 6 Albarran, J., Imbert, L.: Les Tumeurs du Rein. Paris, 1903, p. 501. 6 Zaccarini, G.: Die Solitaren Cystennieren (mikroscopische Beobachtungen), Deutsch. Ztschr. f. chir., 132: 295-314, 1914. 7 Bugbee, H. G. and WoUstein, M.: Surgical pathology of the urinary tract in infants. J. A. M. A., 83: 1887-1894, 1924. 8 D'Antona (quoted by Brin) Des Kystes non Hydatiques du Rein; Symptoms, Diagnostic et Traitement (Rapport), Assoc. franc d'urol, 15: 33-234, 1911. ; Rochet: Chirurg. d. Reins, 1910 (Quoted by Brin).
418
THOMAS S. CHALKLEY AND LEE E. SUT'l'ON, JR.
Case 4. 10 This was a 4½ year old girl who had had a palpable left kidney for 3 years. There was a multilocular cyst the size of 2 fists at the upper pole. The mucosa of the pelvis was stretched. The cysts were all continuous with the pelvis of the kidney, the larger cysts connecting with the smaller cysts. Apparently this might well be a hydronephrosis. The right kidney was normal. Case 5.11 This case was an 8 year old child \vith a cyst in the upper pole of the left kidney the size of an adult head. A nephrectomy was done and the patient died postoperatively. Case 6. 12 This case was a 13 months old girl with a palpable mass and swelling of 4 month's duration. The urine contained many blood and pus cells. At operation a solitary cyst of the lower pole of the right kidney, the size of a small grapefruit, was found. A nephrectomy was done and the child made an uneventful recovery. The cyst contained serous fluid. Case 7. 13 This case was a 3 year old healthy male with an asymptomatic mass in the left kidney region. Kidney function and urine were normal. At operation a cyst, the size of a grapefruit (13 by 10 by 9 cm.), was found at the lower pole of the left kidney. A nephrectomy was done and the child made an uneventful recovery. The cyst was filled with serous fluid. The kidney and cyst together weighed 570 gm. Case 8. 14 This case was a 10 year old female with an asymptomatic mass in the right kidney region. The urine showed no albumin but had 40 pus cells per high power field. Right pyelogram showed a tumor mass. A right nephrectomy was done and the child made an uneventful recovery. The kidney measured 9 by 6 by 6 cm. There was a smooth walled cyst at the middle pole of the kidney containing 30 cubic centimeters of colorless fluid. Case 9. 15 This case was a 13 year old colored male who had a history of Bright's disease 9 years previously. At the time of admission he had urinary symptoms of frequency and burning. Urine contained albumin, red blood cells, pus, and gram-negative bacilli. The phthalein output was 60 per cent. It was impossible to catheterize the renal orifice. A right nephrectomy was done and the child recovered. The kidney was hydronephrotic, measuring 9 by 6 by 4 cm. There was a cyst at the convex surface of the middle pole measuring 4 by 3 by 4 cm., containing clear straw colored fluid. There was an incomplete septum in the cavity of the cyst. There was also a tuberculous cavity at the upper pole of the same kidney containing grey caseous material. Case 10.16 This case was a 2 year old male. He was apathetic. He had a palpable tumor mass bulging from the left flank. Cystoscopic examination was 10 Beneke, R.: Eigenartige Nierenzystengeschwulst, Verhandl. d. Gesellsch Deutsch. Naturf. u. Aerzte, 82: ii, T 15-16, 1911. 11 Weill, Mouriquand, and Gardiere: Pediat. Praet, no. 12, p. 203, 1912. (Quoted by Harpster, Brown, and Delcher.) 12 Mixter, C. G.: Tumors of the kidney in infancy and childhood. Ann. Surg., 76: 5960, 1922. 13 Higgins, C.H.: Solitary cysts of the kidney. Ann. Surg., 93: 868-879, 1931. 14 Allen, C. D. and Ragsdale, J. W.: Solitary cyst of the kidney. Am. J. Surg., 29: 311-312, 1935. 16 LeCompte, R. M. and Whitmore, E. R.: Urol. & Cut. Rev., 39: 864-867, 1935. 16 Vonachen, J. R. and Sprenger, A.: Solitary cyst of the kidney. Ill. Med. Jour., 51: 413-415, 1937.
SOLITARY CYST OF KIDNEY
419
negative, and due to the stenosis it was found impossible to get into the left ureter. The urine was foul smelling and there were profuse pus cells and a few red blood cells. A left nephrectomy was done and the child recovered. A unilocular sac in the upper pole of the left kidney was found. The cyst was thin walled and the surface smooth and glistening. There was no connection between the pelvis and the cyst. It contained 2 liters of straw colored fluid which was negative on culture. The pelvis of the kidney was dilated and the ureter thickened. Of these reported cases, 4 have occurred in females and 4 in males, and in 3 the sex is not mentioned. In 5 of these the cyst has been in the right kidney and in 4 it has been in the left kidney, an.d in two it is not mentioned. Four of these were in the lower pole of the kidney, 4 in the upper pole, and 2 at the middle pole of the kidney. The 6 cases which have been reported since 1922 have all had a nephrectomy, and all have recovered. SUMMARY
A case of a large solitary infected cyst of the kidney in a child is presented with a review of literature of the cases occurring during childhood. So far as we know this is the first case of a spontaneously infected solitary cyst which has occurred during childhood.
AND
LEE E. SUTTON, JR.
From the Department of Pediatrics at the Medical College of Virginia, Richmond
Large solitary renal cysts are rare in children. We have collected 10 cases from the literature and we are adding 1 of our own. However, only the case of Hawkins 1 was infected, and that one only after aspiration had been done. Davidson2 states that spontaneous infection of a solitary renal cyst is quite rare. He has been able to find but 5 cases reported in the literature and he adds 1 of his own. Of these cases, 5 were in adult females and 1 in an adult male. Fang3 adds a case in an adult female. CASE REPORT
A 11 year old colored girl admitted to the Medical College of Virginia Hospital September 6, 1942. The past history and family history were non-contributory. Three weeks previous to admission to the hospital she had a dull pain in the right upper quadrant of her abdomen. This continued steadily up to the time of admission to the hospital. The pain did not radiate and did not occur in relation to meals. She had had a dull headache most of this time. Forty-eight hours previous to admission she noticed a tender mass in the right upper quadrant. She had had 1 white bowel movement on September 5. There had been no nausea or vomiting and bowel movements had been regular. There were no urinary complaints. She was a well developed child for her age. There was a slight icteric tinge to the sclerae. The remainder of the positive physical findings were confined to the abdomen. There was a smooth, tender, deeply palpable, and slightly movable mass in the right upper quadrant. This was about 6 inches in diameter and seemed to extend about 4 finger-breadths below the costal margin just inside the nipple line. It seemed to be free from the liver, and was tender to palpation anteriorly but not particularly so posteriorly. There was no spasm of the recti. A tentative diagnosis of hypernephroma or hydronephrosis of the right kidney was made. Intravenous pyelograms (fig. 1) showed a normally functioning left kidney. The right kidney showed tapering of the calyces with the lower calyx displaced downward with an oval density, apparently cystic, spreading the middle and lower calyces apart and impinging upon the renal pelvis causing it to be markedly deformed. Roentgenological diagnosis was large right kidney tumor or cyst in the lower half of the right kid;ney. Repeated urinalyses showed 0 trace of albumin, and 0-20 white blood cells per high power field. The red blood count was 3,240,000 with 58 per pent hemo1 2 3
Hawkins, Caesar: Medico Chirurgical Rev., 20: 23-24, 1834. Davidson, B.: Infected renal cyst. N. Y. State, J. Med., 40: 875-881, 1940. Fang, C.H.: Solitary cyst of the kidney. Chin. Med. J., 53: 221, 1938. 414
SOLITARY CYST OF KIDNEY
415
globin. The white blood count was 6,000 with 81 per cent polymorphonuclears. The blood non-protein nitrogen was 40 with a total protein of 7.5 and an albumin-globulin ratio of 4.2/3.3. The icteric index was 7 and the cholesterol was 115. The child was seen in tumor clinic and since a diagnosis of malignant tumor was held likely, preoperative x-ray therapy was decided upon. She was given 1250 r units anteriorly and 1000 r to both the lateral and posterior portals. This was a total of 3250 r units in air. Due to the anemia she was given three transfusions preoperatively of 250 cc, 300 cc, and 150 cc.
FrG. 1. Intravenous urogram
On September 10 a cystoscopic examination was done. Attempts to pass a catheter into the right ureter were unsuccessful. This was followed in 2 days by the child having a temperature of 104 ° F and a pulse of 130. She was put on sulfathiazole for 24 hours. The temperature and pulse rapidly returned to normal. On September 29 a right nephrectomy was done by Dr. Austin Dodson. The kidney tissue appeared to be normal at the upper pole, but there was a tense cyst the size of a grape-fruit at the lower pole. This was opened and frank pus obtained. The kidney pelvis showed clear urine. She made an uneventful recovery and was discharged on the twentieth postoperative day.
416
THOMAS S. CHALKLEY AND LEE E. SUTTON, JR.
Dr. J. S. Howe stated that the specimen consisted of a right kidney containing a large incised cyst. The cyst measured 12 cm. in diameter, was thick walled, and was lined by a shaggy ivory colored material. No fluid was present in the cyst at the time the specimen was received. The kidney and pelvis had been incised, but no connection between the cyst and the pelvis was apparent. The calyces were dilated, but were lined with a smooth, glistening, mucosal surface as was the pelvis and ureter. The renal parenchyma, particularly over the cyst, was thin but revealed a well demarcated cortex and medulla. The arcuate arteries did not gap. Where the capsule of the kidney was still present, it could be stripped away with ease revealing a smooth surface. The upperpole of the organ was covered by typical adrenal cortex.
Fm. 2 Fm. 3 Fm. 2. Fibrous cyst wall showing epithelial remnants and chronic inflammatory granulation tissue. (X 115.) Fm. 3. Section showing normal epithelium of pelvis and portion of kidney tissue. (X 180.)
Upon microscopic examination, sections of the cyst wall were found to be composed of dense fibrous connective tissue lined on one surface with chronic inflammatory granulation tissue, with occasional fragments of preserved transitional epithelium (fig. 2). The epithelium lining the pelvis and calcyces was well preserved and showed no inflammatory reaction (fig. 3). One section of the kidney appeared essentially normal but had adhering to the cortex a small amount of adrenal cortex. Sections through the cyst wall and calyx showed no connection between the two although they were separated by only a small amount of kidney tissue. Pathological diagnosis was large solitary cyst of the kidney with suppuration, and moderate hydronephrosis. Culture of fluid from the cyst yielded Staphylococcus albus.
SOLITARY CYST OF KIDNEY
417
DISCUSSION
Hawkins described the first case in the literature in 1833. We have been able to find 9 other cases and to these we are adding one of our own making eleven cases in all, described in children. Wagner's 4 case in a 4½ year old boy has been included by some, but in reviewing his article he claims that there was a double pelvis and ureter on the right side; the upper pelvis and ureter having become hydronephrotic reaching the size of an infant's head. The case of Albarran and Imbert 5 in a 16 months old child has been omitted because there were 7 cysts in one kidney. Their belief was that they were a simple variety of a polycystic kidney. Zaccarini's 6 case in a 3 year old child has been omitted because the kidneys were of normal size, 1 containing a multilocular cyst the size of a hazelnut, and the other kidney a smaller one. Both were in the medulla and contained yellow fluid with blood. Bugbee and W ollstein 7 mention 2 cases of large serous cyst of the kidney occurring in children but no description is given except that in 1 case the opposite kidney was polycystic, and in the other case the opposite kidney presented diffuse nephritis. CASE REPORTS IN LITERATURE
Case 1. Six year old boy with history of being run over; pain and swelling in right side followed accompanied by fever. The tumor involved the entire right side of the abdomen. Two months later 18 ounces of nearly transparent clear fluid was aspirated. He died 2½ months later. The cyst contained 5 pints of the same type of fluid and in addition some white semi-purulent matter. The cyst was at the lower pole and had no communication to the pelvis. There was a third kidney the size of a walnut consisting of a single lobe with cortical and tubular part perfect and having a single mammillary process and calyx but no excretory duct extending from the kidney toward the inner part of the cyst. Case 2. 8 This child was 1 year old and had a large serous cyst resected with recovery following. Case 3. 9 This case was 1 year old and and had a cyst the size of a tangerine which was incised. 4 Wagner, Paul: Vier Operationen mit Eroffnung des Bauchfelles bei Kindern, Arch. f. klin. chir. 30: 517-519, 1884. 6 Albarran, J., Imbert, L.: Les Tumeurs du Rein. Paris, 1903, p. 501. 6 Zaccarini, G.: Die Solitaren Cystennieren (mikroscopische Beobachtungen), Deutsch. Ztschr. f. chir., 132: 295-314, 1914. 7 Bugbee, H. G. and WoUstein, M.: Surgical pathology of the urinary tract in infants. J. A. M. A., 83: 1887-1894, 1924. 8 D'Antona (quoted by Brin) Des Kystes non Hydatiques du Rein; Symptoms, Diagnostic et Traitement (Rapport), Assoc. franc d'urol, 15: 33-234, 1911. ; Rochet: Chirurg. d. Reins, 1910 (Quoted by Brin).
418
THOMAS S. CHALKLEY AND LEE E. SUT'l'ON, JR.
Case 4. 10 This was a 4½ year old girl who had had a palpable left kidney for 3 years. There was a multilocular cyst the size of 2 fists at the upper pole. The mucosa of the pelvis was stretched. The cysts were all continuous with the pelvis of the kidney, the larger cysts connecting with the smaller cysts. Apparently this might well be a hydronephrosis. The right kidney was normal. Case 5.11 This case was an 8 year old child \vith a cyst in the upper pole of the left kidney the size of an adult head. A nephrectomy was done and the patient died postoperatively. Case 6. 12 This case was a 13 months old girl with a palpable mass and swelling of 4 month's duration. The urine contained many blood and pus cells. At operation a solitary cyst of the lower pole of the right kidney, the size of a small grapefruit, was found. A nephrectomy was done and the child made an uneventful recovery. The cyst contained serous fluid. Case 7. 13 This case was a 3 year old healthy male with an asymptomatic mass in the left kidney region. Kidney function and urine were normal. At operation a cyst, the size of a grapefruit (13 by 10 by 9 cm.), was found at the lower pole of the left kidney. A nephrectomy was done and the child made an uneventful recovery. The cyst was filled with serous fluid. The kidney and cyst together weighed 570 gm. Case 8. 14 This case was a 10 year old female with an asymptomatic mass in the right kidney region. The urine showed no albumin but had 40 pus cells per high power field. Right pyelogram showed a tumor mass. A right nephrectomy was done and the child made an uneventful recovery. The kidney measured 9 by 6 by 6 cm. There was a smooth walled cyst at the middle pole of the kidney containing 30 cubic centimeters of colorless fluid. Case 9. 15 This case was a 13 year old colored male who had a history of Bright's disease 9 years previously. At the time of admission he had urinary symptoms of frequency and burning. Urine contained albumin, red blood cells, pus, and gram-negative bacilli. The phthalein output was 60 per cent. It was impossible to catheterize the renal orifice. A right nephrectomy was done and the child recovered. The kidney was hydronephrotic, measuring 9 by 6 by 4 cm. There was a cyst at the convex surface of the middle pole measuring 4 by 3 by 4 cm., containing clear straw colored fluid. There was an incomplete septum in the cavity of the cyst. There was also a tuberculous cavity at the upper pole of the same kidney containing grey caseous material. Case 10.16 This case was a 2 year old male. He was apathetic. He had a palpable tumor mass bulging from the left flank. Cystoscopic examination was 10 Beneke, R.: Eigenartige Nierenzystengeschwulst, Verhandl. d. Gesellsch Deutsch. Naturf. u. Aerzte, 82: ii, T 15-16, 1911. 11 Weill, Mouriquand, and Gardiere: Pediat. Praet, no. 12, p. 203, 1912. (Quoted by Harpster, Brown, and Delcher.) 12 Mixter, C. G.: Tumors of the kidney in infancy and childhood. Ann. Surg., 76: 5960, 1922. 13 Higgins, C.H.: Solitary cysts of the kidney. Ann. Surg., 93: 868-879, 1931. 14 Allen, C. D. and Ragsdale, J. W.: Solitary cyst of the kidney. Am. J. Surg., 29: 311-312, 1935. 16 LeCompte, R. M. and Whitmore, E. R.: Urol. & Cut. Rev., 39: 864-867, 1935. 16 Vonachen, J. R. and Sprenger, A.: Solitary cyst of the kidney. Ill. Med. Jour., 51: 413-415, 1937.
SOLITARY CYST OF KIDNEY
419
negative, and due to the stenosis it was found impossible to get into the left ureter. The urine was foul smelling and there were profuse pus cells and a few red blood cells. A left nephrectomy was done and the child recovered. A unilocular sac in the upper pole of the left kidney was found. The cyst was thin walled and the surface smooth and glistening. There was no connection between the pelvis and the cyst. It contained 2 liters of straw colored fluid which was negative on culture. The pelvis of the kidney was dilated and the ureter thickened. Of these reported cases, 4 have occurred in females and 4 in males, and in 3 the sex is not mentioned. In 5 of these the cyst has been in the right kidney and in 4 it has been in the left kidney, an.d in two it is not mentioned. Four of these were in the lower pole of the kidney, 4 in the upper pole, and 2 at the middle pole of the kidney. The 6 cases which have been reported since 1922 have all had a nephrectomy, and all have recovered. SUMMARY
A case of a large solitary infected cyst of the kidney in a child is presented with a review of literature of the cases occurring during childhood. So far as we know this is the first case of a spontaneously infected solitary cyst which has occurred during childhood.