Presentation
Intermittent left flank pain, fever and dysuria for 3 days.
Patient Data
Enlarged left kidney with significant perinephric fat stranding and left pararenal fascia thickening.
A few areas of lower attenuation with multiple small rims enhancing collections were seen within all poles of left kidney.
A higher attenuating left perinephric collection (45-50HU).
No hydronephrosis and hydroureter. No urinary system calculus. (Higher attenuating content within the non-dilated left renal pelvis is due to contrast excretion from test contrast bolus).
Abdominal lymphadenopathy at the left paraaortic region.
Right kidney appears normal.
Urinary bladder is well distended with in situ urinary bladder catheter. Intraluminal urinary bladder air noted (likely due to catheterization).
Minimal free fluid in pelvis.
Annotated images to show enlarged left kidney with renal and perinephric abscesses.
Case Discussion
Final diagnosis is left acute pyelonephritis complicated with renal and perinephric abscesses. Patient was treated vigorously with intravenous antibiotic (according to the pus culture sensitivity) and ultrasound-guided pigtail drainage of the perinephric abscess.
Patient was newly diagnosed to have diabetes mellitus type 1 with poorly controlled blood sugar. This has predisposed this patient to develop abscess and infection.
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