RESUMEN
OBJECTIVE. The purpose of this article is to review the spectrum, etiopathogenesis, clinical presentation, imaging features, differential diagnoses, and management of emphysematous infections of the abdomen and pelvis. CONCLUSION. Emphysematous infections are associated with high morbidity and mortality and thus need urgent medical and surgical interventions. CT is the most sensitive modality to detect gas; CT provides definitive diagnosis in most cases and can depict the extent of involvement.
Asunto(s)
Enfisema/diagnóstico por imagen , Gases , Tomografía Computarizada por Rayos X , Pared Abdominal/diagnóstico por imagen , Pared Abdominal/microbiología , Absceso/diagnóstico por imagen , Absceso/microbiología , Aortitis/diagnóstico por imagen , Aortitis/microbiología , Cistitis/diagnóstico por imagen , Cistitis/microbiología , Enfisema/microbiología , Colecistitis Enfisematosa/diagnóstico por imagen , Colecistitis Enfisematosa/microbiología , Femenino , Gangrena de Fournier/diagnóstico por imagen , Gangrena de Fournier/microbiología , Gangrena Gaseosa/diagnóstico por imagen , Gangrena Gaseosa/microbiología , Gastritis/diagnóstico por imagen , Gastritis/microbiología , Hepatitis/diagnóstico por imagen , Hepatitis/microbiología , Humanos , Masculino , Pancreatitis/diagnóstico por imagen , Pancreatitis/microbiología , Enfermedades de la Próstata/diagnóstico por imagen , Enfermedades de la Próstata/microbiología , Absceso del Psoas/diagnóstico por imagen , Absceso del Psoas/microbiología , Pielitis/diagnóstico por imagen , Pielitis/microbiología , Pielonefritis/diagnóstico por imagen , Pielonefritis/microbiología , Enfermedades Uterinas/diagnóstico por imagen , Enfermedades Uterinas/microbiologíaRESUMEN
Psoas muscle abscesses associated with emphysematous urinary tract infections are rare. There are not many case reports about urinary tract infections such as emphysematous pyelitis and emphysematous cystitis complicating psoas muscle abscesses. Here, we report a case of an ipsilateral psoas muscle abscess following emphysematous cystitis and emphysematous pyelitis in an 81-year-old diabetic man. He was treated with prolonged antibiotic therapy and other supportive care.
Asunto(s)
Cistitis , Enfisema , Pielitis , Infecciones Urinarias , Masculino , Humanos , Anciano de 80 o más Años , Absceso , Cistitis/diagnóstico , Cistitis/diagnóstico por imagen , Pielitis/diagnóstico , Pielitis/diagnóstico por imagen , Infecciones Urinarias/complicaciones , Infecciones Urinarias/tratamiento farmacológico , Enfisema/complicaciones , Enfisema/diagnóstico por imagenRESUMEN
A 62-year-old asymptomatic woman with diabetes was referred to the urology department from nephrology due to deterioration in renal function with accompanied right-sided hydronephrosis on ultrasound. CT imaging subsequently revealed a right-sided staghorn calculus and a significant volume of gas in the right collecting system from the kidney to the distal ureter, in keeping with emphysematous pyelitis. She was admitted and managed with antibiotics and insertion of right nephrostomy in the first instance, followed by percutaneous nephrolithotomy to definitively manage the stone. The patient remained asymptomatic throughout the process.
Asunto(s)
Enfisema/diagnóstico por imagen , Pielitis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Enfermedades Asintomáticas , Femenino , Humanos , Persona de Mediana EdadAsunto(s)
Enfisema/diagnóstico por imagen , Infecciones por Escherichia coli/diagnóstico por imagen , Escherichia coli/aislamiento & purificación , Riñón/patología , Pielitis/diagnóstico por imagen , Antibacterianos/uso terapéutico , Ceftriaxona/uso terapéutico , Preescolar , Enfisema/tratamiento farmacológico , Enfisema/microbiología , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/microbiología , Femenino , Humanos , Riñón/diagnóstico por imagen , Nefrectomía/métodos , Pielitis/tratamiento farmacológico , Pielitis/microbiología , Tomografía Computarizada por Rayos XRESUMEN
Diabetes mellitus (DM) is a common disease in Oman as in rest of Gulf Cooperation Council where metabolic syndrome is of high prevalence. DM is a foremost risk factor for urinary tract infections (UTIs). It is also linked to more complicated infections such as emphysematous pyelonephritis (EPN), emphysematous pyelitis (EP), renal/perirenal abscess, emphysematous cystitis, xanthogranulomatous pyelonephritis, and renal papillary necrosis. The diagnosis of these cases is frequently delayed because the clinical manifestations are generic and not different from the typical triad of upper UTI, which include fever, flank pain, and pyuria. A middle-aged female with DM and chronic kidney disease stage IV was admitted with recurrent UTI with extended-spectrum beta-lactamase-producing Escherichia coli. At presentation, she was afebrile, clinically stable, had no flank pain and there was no leukocytosis. Laboratory test for C- reactive protein done twice and was only mildly elevated at 7 and 11 mg/dL. A computed tomography scan of kidney-ureter-bladder (CT-KUB) was recommended and reported as "no KUB stone but small atrophic left kidney with dilatation of the pelvicalycial system and ureter and the presence of air in the collecting system suggestive of EP." Thus, commonly associated with DM, especially in females, debilitated immune-deficient individuals, and patients harboring obstructed urinary system with infective nidus. Air in the kidney is not always due to EPN. UTI with a gas-producing organism can ascend to the kidney in the presence of vesicoureteral reflux.
Asunto(s)
Complicaciones de la Diabetes/mortalidad , Enfisema/microbiología , Infecciones por Escherichia coli/microbiología , Pielitis/microbiología , Infecciones Urinarias/microbiología , Reflujo Vesicoureteral/complicaciones , Enfermedades Asintomáticas , Complicaciones de la Diabetes/diagnóstico , Enfisema/diagnóstico por imagen , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/diagnóstico , Femenino , Humanos , Persona de Mediana Edad , Pielitis/diagnóstico por imagen , Recurrencia , Factores de Riesgo , Infecciones Urinarias/complicaciones , Infecciones Urinarias/diagnóstico , Reflujo Vesicoureteral/diagnósticoRESUMEN
Encrusted pyelitis is a chronic urinary tract infection associated with mucosal encrustation induced by urea splitting bacteria. More than 40 bacteria have been implicated but the most frequent is Corynebacterium group D2. Predisposing factors are debilitating chronic diseases and preexisting urological procedures. Immunosoppression is an important cofactor. For these reasons the disease is almost always nosocomially acquired and renal transplant recipients are at particular risk. The symptoms are not specific and long lasting: dysuria, flank pain and gross haematuria are the most frequent; fever is present in two-thirds. The demonstration of urine splitting bacteria in constantly alkaline urines and radiological evidence of extensive calcification of pelvicalyceal system, ureter and bladder at US or CT scan in a clinical context of predisposing factors are the mainstay of diagnosis. Treatment is based on adapted antibiotic therapy, acidification of urine and excision of plaques of calcified encrustation. The prognosis relies on timing of diagnosis; delay can be detrimental and result in patient's death and graft loss. We describe a unique case of 69-year-old man with two contemporary diseases: autoimmune thrombotic thrombocytopenic purpura and encrusted pyelitis with a fatal evolution.
Asunto(s)
Infecciones por Enterobacteriaceae/etiología , Morganella morganii/aislamiento & purificación , Nefrocalcinosis/etiología , Púrpura Trombocitopénica Trombótica/complicaciones , Pielitis/etiología , Infecciones Estafilocócicas/etiología , Anciano , Antibacterianos/uso terapéutico , Coinfección/tratamiento farmacológico , Terapia Combinada , Susceptibilidad a Enfermedades , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Resultado Fatal , Hematuria/etiología , Humanos , Hidronefrosis/diagnóstico por imagen , Hidronefrosis/etiología , Masculino , Nefrocalcinosis/diagnóstico por imagen , Nefrotomía , Intercambio Plasmático , Púrpura Trombocitopénica Trombótica/tratamiento farmacológico , Púrpura Trombocitopénica Trombótica/terapia , Pielitis/diagnóstico por imagen , Pielitis/tratamiento farmacológico , Rituximab/uso terapéutico , Infecciones Estafilocócicas/tratamiento farmacológicoAsunto(s)
Infecciones por Corynebacterium/diagnóstico por imagen , Cistitis/diagnóstico por imagen , Pielitis/diagnóstico por imagen , Anciano de 80 o más Años , Infecciones por Corynebacterium/complicaciones , Cistitis/complicaciones , Humanos , Masculino , Pielitis/complicaciones , Tomografía Computarizada por Rayos XAsunto(s)
Infecciones por Corynebacterium/diagnóstico por imagen , Pelvis Renal/diagnóstico por imagen , Trasplante de Riñón , Pielitis/diagnóstico por imagen , Enfermedad Crónica , Infecciones por Corynebacterium/diagnóstico , Infecciones por Corynebacterium/tratamiento farmacológico , Humanos , Fallo Renal Crónico/microbiología , Fallo Renal Crónico/terapia , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/diagnóstico por imagen , Infecciones Oportunistas/tratamiento farmacológico , Pielitis/diagnóstico , Pielitis/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Uréter/diagnóstico por imagenAsunto(s)
Catéteres de Permanencia , Cistitis/diagnóstico por imagen , Cistostomía , Enfisema/diagnóstico por imagen , Infecciones por Enterobacteriaceae/diagnóstico , Pielitis/diagnóstico por imagen , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Citrobacter , Cistitis/tratamiento farmacológico , Enterobacter cloacae , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Humanos , Masculino , Hiperplasia Prostática/complicaciones , Pielitis/tratamiento farmacológico , Estrechez Uretral/complicaciones , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Obstrucción del Cuello de la Vejiga Urinaria/terapia , Infecciones UrinariasRESUMEN
A 64-year-old male patient diagnosed with amyotrophic lateral sclerosis 2 years ago was admitted with fever and chills. The patient had complex medical history and several indwelling catheters/tubes in his body. To identify the infection focus, 67Ga whole-body scintigraphy and SPECT/CT were obtained. 67Ga whole-body scintigraphy demonstrated focal 67Ga uptake in the lower pelvic cavity and the right kidney. Additional Ga SPECT/CT images were obtained, and it enabled characterization of these uptakes as infection of bladder stones that result in pyelitis.
Asunto(s)
Pielitis/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X , Cálculos de la Vejiga Urinaria/diagnóstico por imagen , Radioisótopos de Galio , Humanos , Masculino , Persona de Mediana Edad , Imagen Multimodal , Radiofármacos , Imagen de Cuerpo EnteroAsunto(s)
Cistitis/complicaciones , Enfisema/complicaciones , Pielitis/complicaciones , Anciano , Cistitis/diagnóstico por imagen , Enfisema/diagnóstico por imagen , Resultado Fatal , Humanos , Klebsiella pneumoniae/aislamiento & purificación , Masculino , Pielitis/diagnóstico por imagen , Choque Séptico/etiologíaAsunto(s)
Calcinosis/diagnóstico por imagen , Infecciones por Corynebacterium/diagnóstico por imagen , Pielitis/diagnóstico por imagen , Enfermedades Ureterales/diagnóstico por imagen , Corynebacterium/metabolismo , Hematuria/etiología , Humanos , Riñón/diagnóstico por imagen , Cálculos Renales/diagnóstico por imagen , Cálculos Renales/microbiología , Pielitis/microbiología , Radiografía , Uréter/diagnóstico por imagen , Enfermedades Ureterales/microbiología , UrinálisisRESUMEN
Emphysematous renal infection is a severe, rare complication of urinary tract infection associated with gas production, which frequently causes renal destruction and has a high mortality rate. It is termed emphysematous pyelitis when gas is confined to the collecting system, or emphysematous pyelonephritis if it also involves the parenchyma with or without the perirenal space. Only 7 cases of perirenal emphysema have been described previously; all were in diabetics. Here we present a rare case of gas-producing renal infection in the collecting system and perirenal tissues, in a nondiabetic patient, and discuss the management of the various types of emphysematous renal infections.
Asunto(s)
Nefropatías Diabéticas , Enfisema/diagnóstico por imagen , Pielitis/diagnóstico por imagen , Infecciones Urinarias/diagnóstico por imagen , Niño , Enfisema/etiología , Femenino , Humanos , Pielitis/etiología , Radiografía , Infecciones Urinarias/complicacionesRESUMEN
OBJECTIVES: To refine the clinical and radiologic description of an unusual benign disease, cystic pyeloureteritis (CPU), consisting of the appearance of suburothelial cysts that raise the mucosa layer of the urothelium. We also studied its relationship with various types of inflammation, including chronic infection, that may be the stimulus for the appearance of CPU. METHODS: We compiled 34 cases of CPU covering the period 1976 to 1994, analyzing the clinical manifestations, diagnostic procedures, differential diagnosis, and evolution. RESULTS: There are no specific symptoms associated with the presence of cysts. The average age of the patients was 59 years (range 30 to 77). Urinary tract infection was detected in 18 (53%). The pyeloureteritis was unilateral in 27 (79%) and bilateral in 7 (21%) of the patients. The location of the cysts was as follows: 1 pyelic (3%); 6 pyeloureteral (18%); and 27 (79%) ureteral. Resolution of the radiologic alterations depends on the resolution of the associated pathology: infections, lithiasis, and obstruction. CONCLUSIONS: We conclude that CPU is a benign pathology with indolent evolution and variable duration; it is not associated with sequelae. Diagnosis is made on the basis of radiologic findings, mainly intravenous urography; in view of the minor entity of the pathology, biopsy is not advisable if the radiologic findings are conclusive.
Asunto(s)
Quistes/diagnóstico , Pielitis/diagnóstico , Enfermedades Ureterales/diagnóstico , Adulto , Anciano , Quistes/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Pelvis Renal/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pielitis/diagnóstico por imagen , Radiografía , Uréter/diagnóstico por imagen , Enfermedades Ureterales/diagnóstico por imagenRESUMEN
Fifty malignant and 50 benign renal lesions, with an hypovascular pattern, were classified into four groups on the basis of their vascular morphology. Three of these groups consisted of circumscribed masses distinguished as avascular lesions, lesions with peripheral vascularity and lesions with central vascularity. The fourth group consisted of diffuse or multicentric hypovascular lesions, which were also space-occupying. This grouping confirmed that histologically similar processes can produce widely differing vascular patterns and that they were therefore found in all groups (polymorphy). On the other hand, masses of different aetiology could show practically identical vascular patterns (isomorphy). In order to reduce errors in the diagnosis of hypovascular lesions, the value of individual features was analysed. Part I of this paper deals with the angiographic changes within the tumour. An analysis of the frequency of various phenomena in malignant and benign lesions (total index) permitted conclusions concerning their diagnostic value.
Asunto(s)
Enfermedades Renales/diagnóstico por imagen , Neoplasias Renales/diagnóstico por imagen , Riñón/irrigación sanguínea , Angiografía , Diagnóstico Diferencial , Humanos , Enfermedades Renales Quísticas/diagnóstico por imagen , Neoplasias Renales/irrigación sanguínea , Neoplasias Renales/clasificación , Pelvis Renal/irrigación sanguínea , Pelvis Renal/diagnóstico por imagen , Pielitis/diagnóstico por imagen , Pielonefritis/diagnóstico por imagen , Teratoma/diagnóstico por imagenRESUMEN
PURPOSE: Its described three cases of Corynebacterium urealyticum (CU) infection in patients with renal transplantation and one of its most serious consequences: encrusted pyelitis and cystitis. It is explained the principal keys for its diagnosis, based in the appearance of alkaline pH in in urine analysis (alkaline urine), positives urinary cultures for CU, and the CT and US studies revealed the characteristic images of calcifications in the wall of renal pelvis and bladder. PATIENTS: Three male patients with renal transplantation and CU infection that caused encrusted pyelitis in two of the cases and encrusted cystitis in one case. RESULTS: Calcifications of the urinary tract were noticed in CT in all the patients. In two cases bladder stones were linear, and in the third case they were fundamentally coarse and placed in pelvis. The diagnosis suspicion showed by the images was confirmed by the use of prolonged urine cultures, necessary for detecting CU. All the patients were treated with vancomycin, with success in two of the cases and, finally needing surgery, and after loss of the graft, in the other case. CONCLUSION: Encrusted pyelitis and cystitis are cronic and severe infections of the urinary tract. Calcic struvite incrustations in the urothelium are characteristics of this infection. CT is a choice technique for the diagnosis and followup of the calcifications after treatment.
Asunto(s)
Infecciones por Corynebacterium/diagnóstico por imagen , Corynebacterium/aislamiento & purificación , Cistitis/diagnóstico por imagen , Trasplante de Riñón/efectos adversos , Pielitis/diagnóstico por imagen , Adulto , Antibacterianos/uso terapéutico , Infecciones por Corynebacterium/tratamiento farmacológico , Cistitis/tratamiento farmacológico , Humanos , Riñón/patología , Riñón/cirugía , Trasplante de Riñón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pielitis/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía , Vancomicina/uso terapéuticoRESUMEN
A series of 40 cases of cystic pyeloureteritis (CPU) is reported, this affection being considered as rare since only about 150 cases have been described in the literature. The lesion is probably more prevalent than was once believed but many cases probably remain unrecognized because of the paucity of radiologic signs. Based on findings in these 40 patients, results of radiologic imaging are described, the technical precautions needed for its detection emphasized and differential diagnoses discussed, none of which presents insurmountable obstacles since these are more theoretical than real. Pathogenesis is thought to be an acquired particular form of urinary mucosa metaplasia associated with urinary tract lesions responsible for stasis or chronic inflammation. Treatment should be conservative because of the usual benign nature of the lesion, although exceptional but possible occlusion by the lesions necessitates a certain surveillance.
Asunto(s)
Pielitis/diagnóstico por imagen , Enfermedades Ureterales/diagnóstico por imagen , Adolescente , Adulto , Anciano , Niño , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , RadiografíaRESUMEN
The pyelitis or cystic pyeloureteritis is a rare disease of unknown etiology. The clinic is unspecific and the treatment, medical and expectant. The importance of this disease consists of a correct differential diagnosis with other repletion defect imaging in the excretory tract and its frequent association to other diseases.