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Stage III xanthogranulomatous pyelonephritis with sarcomatoid degeneration
Avallone Roberta1, Rosita Comune1, Francesco Mazzei2
1Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy.
Radiology Case Reports
|October 10, 2024
Summary
Xanthogranulomatous pyelonephritis (XGP) is a rare kidney disease often linked to stones and diabetes. This case highlights imaging
Area of Science:
- Nephrology
- Radiology
- Oncology
Background:
- Xanthogranulomatous pyelonephritis (XGP) is a rare, chronic kidney disease with unknown causes.
- Risk factors include kidney stones, diabetes, recurrent UTIs, and immunocompromised states.
- XGP is associated with an increased risk of kidney cancer, affecting up to 11% of patients.
Observation:
- A 76-year-old female with a history of renal stones and diabetes presented with abdominal and back pain.
- Physical exam revealed a painful skin fistula in the right lumbar region.
- CT imaging showed a nonfunctioning right kidney with necrotic cavities, hepatic inflammation, and a nephro-cutaneous fistula, suggestive of XGP.
Findings:
- CT scans indicated a suspicious, hyper-vascularized renal mass with irregular walls.
- Contrast-enhanced ultrasound (CEUS) confirmed the suspicious mass.
- Pathology revealed chronic pyelonephritis and a sarcomatoid lesion, confirming malignancy.
Implications:
- This case emphasizes the importance of multimodality imaging in emergency settings for accurate diagnosis and management.
- MDCT is the gold standard for XGP diagnosis and staging.
- CEUS can enhance diagnostic accuracy for uncertain renal masses detected on CT.
Keywords:
Acute abdominal painBear paw signCancerCeusFistulaGreat imitatorNephrectomyPyonephrosisSarcomatoid degenerationUsXanthogranulomatous pyelonephritisMore Related Videos
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