Presentation
Reduced renal function, left flank pain with increased inflammatory markers and low-grade fever.
Patient Data
CT demonstrates enlargement of the left kidney, that displaces the spleen forward, with low density and distended appearance of the renal calyces. Scattered air blisters are seen related to a hypodense collection with peripheral enhancement which is partly not differentiated from the dilated calyces, denoting retroperitoneal abscess formation. A large stone is observed inside a calyx at the lower pole of the left kidney. The findings advocate diffuse retroperitoneal extension of the disease (stage III).
Zoomed image from the CT. The dilated low-density calyces surrounded by thin renal parenchyma showing contrast enhancement can be compared to a bear paw.
Description of the image:
author: pixabay
original file: https://pixabay.com/el/vectors/πατημασιές-αρκούδα-νύχια-πόδια-48031/
modifications: cropped image
Case Discussion
This appearance is characteristic of xanthogranulomatous pyelonephritis. Αdditional finding is the formation of a pararenal abscess.
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