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Renal fungal ball: an unusual sonographic finding
Hrishikesh Kale1, Ranjeet S Narlawar, Krantikumar Rathod
1Department of Radiology, King Edward Memorial Hospital, Parel, Mumbai 400 012, India.
Abstract:
Fungal infections of the urinary tract tend to occur in the drainage structures instead of the renal parenchyma. In patients with systemic candidiasis, the kidney is vulnerable to the formation of cortical abscesses or obstructive intrarenal masses ("fungal balls"), usually at the ureteropelvic junction. We describe the case of a boy who presented with dysuria, fever, and chills. Sonographic examination showed mild enlargement of both kidneys and moderate dilatation of the pelvicaliceal system bilaterally. A well-defined, echogenic, oval, mobile mass measuring 2.5 x 2.0 cm, without posterior acoustic shadowing, was visualized in the pelvis of the left kidney. The upper and middle ureters were dilated bilaterally. A urine culture revealed hyphae of Candida albicans. The child received systemic antifungal therapy with fluconazole for 3 weeks. Follow-up sonography showed complete resolution of the mass (a fungal ball) with residual hydronephrosis.
Insights
A pediatric fungal ball, a rare urinary tract infection caused by Candida albicans, was successfully treated with fluconazole. This case highlights the importance of early diagnosis and intervention for fungal kidney infections in children.
Area of Science:
- Pediatric Nephrology
- Mycology
- Diagnostic Imaging
Background:
- Urinary tract fungal infections typically affect drainage structures, not renal parenchyma.
- Systemic candidiasis can lead to renal cortical abscesses or obstructive fungal balls, often at the ureteropelvic junction.
Observation:
- A boy presented with dysuria, fever, and chills.
- Sonography revealed bilateral kidney enlargement and pelvicaliceal dilatation.
- A mobile, echogenic mass (fungal ball) was identified in the left kidney pelvis.
Findings:
- Urine culture confirmed Candida albicans hyphae.
- Systemic antifungal therapy with fluconazole was administered for 3 weeks.
- Follow-up sonography showed complete resolution of the fungal ball.
Implications:
- This case demonstrates the successful management of a pediatric renal fungal ball.
- Early diagnosis and prompt antifungal treatment are crucial for favorable outcomes.
- Residual hydronephrosis may require ongoing monitoring.