Presentation
Right-sided back and flank pain. Recent history of symptoms of right flank pain 2 weeks ago with fevers and chills that was not treated by antibiotics.
Patient Data
Genitourinary:
There is a multi loculated 3.7 x 3.8 x 3.8 cm mass/fluid collection in the upper pole of the right kidney. There are 2-3 centrally located fluid collections, the largest measuring 2.5 x 2.1 cm and the smaller collection slightly more caudally measuring 1.4 x 1.6 cm. A third linear collection is noted along the edge of the kidney extending into the perinephric space with inflammatory change in the perinephric space posterior to the right kidney. The renal parenchyma adjacent to this multiloculated fluid collection is heterogeneous. There is moderate asymmetric thickening of the right hemidiaphragm posteromedial to the right kidney with inflammatory stranding extending up to the diaphragm.
Lower thorax:
There is a small right pleural effusion with mild bibasilar atelectasis.
Lymph nodes:
Multiple prominent periaortic and right pericaval lymph nodes adjacent to the right kidney with largest measuring up to 1.2 cm short axis. There are also mildly enlarged retrocrural lymph nodes.
Case Discussion
This is a highly suspected case of a right renal abscess given the imaging findings and clinical information. Even though urine and blood cultures were negative on admission, the patient was treated with intravenous antibiotics and began to improve clinically. She was discharged without complication and follows urology as an outpatient.
CO-AUTHORS:
Rebecca Kish, MD
Christine Cooley, MD
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