Presentation
Chronic right flank pain.
Patient Data
Normal right kidney is not seen and is almost completely destroyed with significant surrounding fat stranding and fibrotic tissue formation extending to the perirenal and pararenal spaces. Abnormal collection (8.9 cm x 5.5 cm x 8 cm) in the right peri-renal region abutting the postero-lateral abdominal wall. Another collection is seen superior to the renal lodge in the sub-hepatic region measuring 4.6 cm x 4.3 cm x 4.7 cm.
This abnormal collection and fibrotic tissue is closely abutting the second part of the duodenum and the ascending colon with possible fistulation with the duodenum. Large radio-dense stone is noted at the region of the right renal pelvis with few other calcifications.
Case Discussion
The features represent chronic xanthogranulomatous pyelonephritis stage III with possible fistulation to the duodenum.
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