XANTHOGRANULOMATOUS PYELONEPHRITIS
Findings:
Bulky left kidney with mild perinephric fat stranding and thickened all three fascias.
Radiodense calculi are noted in left renal pelvis and calyces.
Peripherally enhancing collection noted in left perinephric space with extension in left pararenal space.
Dilatation of all calyces in left kidney, giving “Bear’s paw sign”
Few air foci noted in left upper and mid pole calyx and left anterior pararenal space.
Non-excreting left kidney.
Above findings suggest possibility of changes of xanthogranulomatous pyelonephritis with emphysematous changes.
Discussion :
Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis and represents a chronic granulomatous disease resulting in a non-functioning kidney.
The clinical presentation is typically vague, consisting of constitutional symptoms such as malaise, weight loss and low-grade fever. Hematuria and flank pain are sometimes encountered.
Staging of disease:
Stage I: the disease is confined to the renal parenchyma only.
Stage II: involves renal parenchyma as well as an extension to perirenal/perinephric fat.
Stage III: the disease extends into the perirenal and pararenal spaces or diffuse retroperitoneum
CT is best modality for reaching the correct diagnosis.
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