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Renal abscess
The Journal of Emergency Medicine, Vol. 31, No. 1, pp. 99 –100, 2006 Copyright © 2006 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/06 $–see front matter
doi:10.1016/j.jemermed.2005.08.015
Visual Diagnosis in Emergency Medicine
RENAL ABSCESS Glenn K. Geeting,
MD,*†
and Naushad Shaikh,
MD‡
*Department of Emergency Medicine, Fitzgerald Mercy Medical Center, Darby, Pennsylvania, †Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, and ‡Department of Internal Medicine, Fitzgerald Mercy Medicine Center, Darby, Pennsylvania Reprint Address: Glenn K. Geeting, MD, Department of Emergency Medicine, Penn State Hershey Medical Center, 500 University Drive, Hershey, PA 17033
CASE REPORT A 29-year-old man presented to the Emergency Department with a 2-week history of right flank pain exacerbated by deep breaths and coughing. He also complained of low grade fever, nausea, and loss of appetite. Four days before presentation, his primary physician had prescribed oral antibiotics and analgesics for a suspected pneumonia. He had no other significant past medical or surgical history and had not traveled outside of the United States for 4 years. Initial vital signs were normal except for a temperature of 38.7°C (101.7°F) and respiratory rate of 24 breaths/min. Physical examination was unremarkable except for right costo-vertebral angle and right upper quadrant tenderness without peritoneal signs. Microscopic urine analysis showed 20 –30 white blood cells and few bacteria. Blood tests were unremarkable except for a white blood count of 14.0 with 81% segmented neutrophils. Chest X-ray study showed no pathology. Bedside ultrasound evaluation of the gallbladder was unremarkable. However, a well-defined cystic mass was noted in the lower pole of the right kidney with internal echoes and an 8-cm diameter (Figure 1). A computed tomography (CT) scan of the abdomen showed a large right renal cyst of similar dimensions and several punctate calcifications (Figure 2). Ureteral calculi and hydronephrosis were absent.
RECEIVED: 16 April 2003; FINAL ACCEPTED: 4 August 2005
SUBMISSION RECEIVED:
Figure 1. Bedside ultrasound image revealing a large cystic structure within the right kidney.
Aspiration of the cavity initially yielded 160 cc of thick greenish-gray pus, which cultures revealed to be Staphylococcus aureus. Percutaneous drainage and antibiotics resulted in resolution of both the abscess and the associated symptoms.
DISCUSSION Renal abscesses often result from the spread of an initial urinary tract infection, usually involving organisms such
22 April 2004; 99
100
G. K. Geeting and N. Shaikh
as E. coli, Klebsiella species, and Proteus species (1). S. aureus is more commonly a result of hematogenous spread, so it is likely that the bacteria causing this abscess were blood-borne. However, this patient had no evidence of intravenous drug use, endocarditis, nephrolithiasis, recent urinary tract infection, or other source of infection.
REFERENCES
Figure 2. CT scan image of the right kidney abscess done before drainage.
1. Kasper DL, Zaleznik DF. Intraabdominal infections and abscesses. In: Kasper DL, Braunwald E, Fauci A, Hauser S, Longo D, Jameson JL, eds. Harrison’s principles of internal medicine, 16th edn. New York: McGraw-Hill; 2005:753– 4.
doi:10.1016/j.jemermed.2005.08.015
Visual Diagnosis in Emergency Medicine
RENAL ABSCESS Glenn K. Geeting,
MD,*†
and Naushad Shaikh,
MD‡
*Department of Emergency Medicine, Fitzgerald Mercy Medical Center, Darby, Pennsylvania, †Department of Emergency Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, and ‡Department of Internal Medicine, Fitzgerald Mercy Medicine Center, Darby, Pennsylvania Reprint Address: Glenn K. Geeting, MD, Department of Emergency Medicine, Penn State Hershey Medical Center, 500 University Drive, Hershey, PA 17033
CASE REPORT A 29-year-old man presented to the Emergency Department with a 2-week history of right flank pain exacerbated by deep breaths and coughing. He also complained of low grade fever, nausea, and loss of appetite. Four days before presentation, his primary physician had prescribed oral antibiotics and analgesics for a suspected pneumonia. He had no other significant past medical or surgical history and had not traveled outside of the United States for 4 years. Initial vital signs were normal except for a temperature of 38.7°C (101.7°F) and respiratory rate of 24 breaths/min. Physical examination was unremarkable except for right costo-vertebral angle and right upper quadrant tenderness without peritoneal signs. Microscopic urine analysis showed 20 –30 white blood cells and few bacteria. Blood tests were unremarkable except for a white blood count of 14.0 with 81% segmented neutrophils. Chest X-ray study showed no pathology. Bedside ultrasound evaluation of the gallbladder was unremarkable. However, a well-defined cystic mass was noted in the lower pole of the right kidney with internal echoes and an 8-cm diameter (Figure 1). A computed tomography (CT) scan of the abdomen showed a large right renal cyst of similar dimensions and several punctate calcifications (Figure 2). Ureteral calculi and hydronephrosis were absent.
RECEIVED: 16 April 2003; FINAL ACCEPTED: 4 August 2005
SUBMISSION RECEIVED:
Figure 1. Bedside ultrasound image revealing a large cystic structure within the right kidney.
Aspiration of the cavity initially yielded 160 cc of thick greenish-gray pus, which cultures revealed to be Staphylococcus aureus. Percutaneous drainage and antibiotics resulted in resolution of both the abscess and the associated symptoms.
DISCUSSION Renal abscesses often result from the spread of an initial urinary tract infection, usually involving organisms such
22 April 2004; 99
100
G. K. Geeting and N. Shaikh
as E. coli, Klebsiella species, and Proteus species (1). S. aureus is more commonly a result of hematogenous spread, so it is likely that the bacteria causing this abscess were blood-borne. However, this patient had no evidence of intravenous drug use, endocarditis, nephrolithiasis, recent urinary tract infection, or other source of infection.
REFERENCES
Figure 2. CT scan image of the right kidney abscess done before drainage.
1. Kasper DL, Zaleznik DF. Intraabdominal infections and abscesses. In: Kasper DL, Braunwald E, Fauci A, Hauser S, Longo D, Jameson JL, eds. Harrison’s principles of internal medicine, 16th edn. New York: McGraw-Hill; 2005:753– 4.