- Email: [email protected]
Ruptured fornix demonstrated during abscess drainage
IMAGES IN CLINICAL UROLOGY
RUPTURED FORNIX DEMONSTRATED DURING ABSCESS DRAINAGE WEN Y. WANG, ISRAEL SCHUR,
AND
WEN L. WANG
A
46 year-old diabetic man, an intravenous drug abuser, presented with right flank pain and fever 1 day prior to admission. Laboratory studies and vital signs were consistent with sepsis related to acute bacterial pyelonephritis and he was started on broad spectrum intravenous antibiotics. Computed tomography (CT) of the abdomen revealed an enlarged inhomogeneous reniform mass in the right renal fossa (Fig. 1). Ultrasound revealed the presence of a complex right perinephric collection. During percutaneous placement of a drainage catheter, contrast material was injected, revealing contrast opacification of the right perinephric collection, with fistulous communication with a lower pole calyx and opacification of the collecting system (Fig. 2). A percutaneous drainage catheter was left to drain the right perinephric abscess (Fig. 3). Urine culture grew Serratia marcesens. Culture of the perinephric abscess grew Staphylococcus aureus. The mixed bacterial organisms are likely a result of the patient’s intravenous drug abuse. The drainage catheter was left in place for 1 week and his clinical condition dramatically improved while on intravenous antibiotic therapy. A follow-up CT From the Department of Radiology, St. Luke’s–Roosevelt Hospital Center, New York, New York; and Queens–Long Island Medical Group, Elmhurst, New York Reprint requests: Wen Y. Wang, M.D., Section of Vascular and Interventional Radiology, Department of Radiology, St. Luke’s– Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY 10025 Received: January 9, 1998, accepted (with revisions): April 17, 1998
320
© 1998, ELSEVIER SCIENCE INC. ALL RIGHTS RESERVED
FIGURE 1. CT image shows an enlarged right kidney with an area of decreased attenuation in the lower pole.
scan showed resolution of the perinephric abscess with minimal residual thickening in the posterior right perinephric space (Fig. 4). The unusual feature of this case is the demonstration of the fistulous communication of the perinephric abscess with the lower pole calyx. The radiologic finding supports the presence of a previously ruptured fornix complicating the clinical diagnosis of acute bacterial pyelonephritis. The combination of percutaneous drainage of the perinephric abscess with intravenous antibiotics and hydration resulted in rapid clinical improvement despite the severity of the infection.
0090-4295/98/$19.00 PII S0090-4295(98)00196-4
FIGURE 2. Contrast study demonstrates opacification of the right perinephric collection with fistulous communication with the collecting system.
FIGURE 3. CT image at the level of the kidneys shows a percutaneous drainage catheter within the right perinephric collection.
UROLOGY 52 (2), 1998
FIGURE 4. Contrast-enhanced CT shows resolution of the right perinephric collection and normal appearance of the right kidney. The drainage catheter has been removed. There is minimal residual postinflammatory thickening remaining.
321
RUPTURED FORNIX DEMONSTRATED DURING ABSCESS DRAINAGE WEN Y. WANG, ISRAEL SCHUR,
AND
WEN L. WANG
A
46 year-old diabetic man, an intravenous drug abuser, presented with right flank pain and fever 1 day prior to admission. Laboratory studies and vital signs were consistent with sepsis related to acute bacterial pyelonephritis and he was started on broad spectrum intravenous antibiotics. Computed tomography (CT) of the abdomen revealed an enlarged inhomogeneous reniform mass in the right renal fossa (Fig. 1). Ultrasound revealed the presence of a complex right perinephric collection. During percutaneous placement of a drainage catheter, contrast material was injected, revealing contrast opacification of the right perinephric collection, with fistulous communication with a lower pole calyx and opacification of the collecting system (Fig. 2). A percutaneous drainage catheter was left to drain the right perinephric abscess (Fig. 3). Urine culture grew Serratia marcesens. Culture of the perinephric abscess grew Staphylococcus aureus. The mixed bacterial organisms are likely a result of the patient’s intravenous drug abuse. The drainage catheter was left in place for 1 week and his clinical condition dramatically improved while on intravenous antibiotic therapy. A follow-up CT From the Department of Radiology, St. Luke’s–Roosevelt Hospital Center, New York, New York; and Queens–Long Island Medical Group, Elmhurst, New York Reprint requests: Wen Y. Wang, M.D., Section of Vascular and Interventional Radiology, Department of Radiology, St. Luke’s– Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY 10025 Received: January 9, 1998, accepted (with revisions): April 17, 1998
320
© 1998, ELSEVIER SCIENCE INC. ALL RIGHTS RESERVED
FIGURE 1. CT image shows an enlarged right kidney with an area of decreased attenuation in the lower pole.
scan showed resolution of the perinephric abscess with minimal residual thickening in the posterior right perinephric space (Fig. 4). The unusual feature of this case is the demonstration of the fistulous communication of the perinephric abscess with the lower pole calyx. The radiologic finding supports the presence of a previously ruptured fornix complicating the clinical diagnosis of acute bacterial pyelonephritis. The combination of percutaneous drainage of the perinephric abscess with intravenous antibiotics and hydration resulted in rapid clinical improvement despite the severity of the infection.
0090-4295/98/$19.00 PII S0090-4295(98)00196-4
FIGURE 2. Contrast study demonstrates opacification of the right perinephric collection with fistulous communication with the collecting system.
FIGURE 3. CT image at the level of the kidneys shows a percutaneous drainage catheter within the right perinephric collection.
UROLOGY 52 (2), 1998
FIGURE 4. Contrast-enhanced CT shows resolution of the right perinephric collection and normal appearance of the right kidney. The drainage catheter has been removed. There is minimal residual postinflammatory thickening remaining.
321