Presentation
Right flank pain with fever and weight loss in a paraplegic patient with neurogenic bladder following a road traffic accident 7 years ago.
Patient Data
CT scan demonstrates:
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right kidney:
enlarged with a distorted renal outline
dilated multiloculated calyces giving the appearance of a paw print of a bear "bear's paw sign"
contracted renal pelvis containing stone with a thick enhanced wall (pyelitis) as well as small stones in the middle calyx
perinephric abscess formation with thickening of Gerota's fascia.
no significant excretion on the CT urogram
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left kidney
enlarged with hydroureteronephrosis
No renal or ureteric stone
the urinary bladder is small and contracted with a thick enhanced pseudo-diverticular wall, containing three large stones
L2 vertebral body fracture stabilized by transpedicular screw fixation
Case Discussion
Case showing the imaging features of xanthogranulomatous pyelonephritis complicated by a perinephric abscess in a patient with a neurogenic bladder and left hydroureteronephrosis following RTA.
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