System Imaging in Unexplained Fever
Benedict Isaac, Serge Kernbaum, Michael Burke in Unexplained Fever, 2019
As in most imaging modalities, ultrasound is unable to provide a tissue-specific diagnosis. However, renal sonography is particularly well suited in determining the characterization of renal masses. Lesions in excess of 2 cm in diameter will usually be detected by their sonographic appearance in the kidney.26 Ultrasonography is able to detect simple renal cysts more accurately.27 Less commonly, an abscess will be indistinguishable from a simple cyst on ultrasonography.28 Other cystic lesions of the kidney, detectable by ultrasonography as a cause of fever, include cystic and necrotic tumors, pyonephrosis, abscesses, tuberculous cavities, and infected cysts. Needle aspiration aided by organismal or cytological identification is usually required to finalize the diagnosis. Renal cell carcinoma, apart from being a solid lesion, may develop a cystic component by virtue of extensive necrosis, or develop in the wall of a pre-existing renal cyst. Solid renal masses that may masquerade as possible malignancies include metastases, acute focal bacterial nephritis, lymphoma, sarcoma, and focal xanthogranulomatous inflammation.29 Ultrasonography is a mandatory investigation for the detection of renal pathology as a cause of fever.
Urinary system
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
Renal cysts are easily detectable; an example is shown in Fig. 7.5b. These are very common and of no clinical significance in the absence of symptoms and if they have no internal structure. A renal cyst with internal content should be investigated further, and while CT scanning has long been the gold standard for staging of complex renal cystic masses using the Bosniak classification, recent studies are showing excellent results with CEUS [9].
Paper 4
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw in The Final FRCR, 2020
A 32 year old female patient has an abdominal ultrasound requested by the GP following several urinary tract infections. The right kidney measures 8.2 cm in length and the left kidney measures 10.4 cm. The right renal artery to aortic velocity ratio is 3.7 and the left is 2.6. The kidneys appear structurally normal with no hydronephrosis and no renal calculi identified. There is a 13-mm simple right renal cyst. The urinary bladder appears thin walled.
The safety and efficacy of laparoscopic microwave ablation-assisted partial nephrectomy: a new avenue for the treatment of cystic renal tumors
Published in International Journal of Hyperthermia, 2023
Baoan Hong, Qiang Zhao, Yongpeng Ji, Yong Yang, Ning Zhang
According to current guidelines, partial nephrectomy remains the standard treatment for localized small renal tumors, intending to preserve kidney function and provide longer term tumor control [6]. Some theoretical questions regarding treating cystic renal tumors remain unanswered, especially concerns about cyst rupture and tumor implantation during surgery. Firstly, patients with renal cysts on preoperative imaging, receiving renal cyst unroofing, may be diagnosed as cystic renal cell carcinoma by postoperative pathology. Second, for patients with a high suspicion of cystic renal cell carcinoma, cyst rupture may occur during nephron-sparing surgery, and this carries the risk of tumor implantation and metastasis. The rate of cyst rupture during partial nephrectomy has been reported to be 20% [7,8].
Renal and perinephric abscesses involving Lactobacillus jensenii and Prevotella bivia in a young woman following ureteral stent procedure
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Abhinav Mohan, Jacob Rubin, Priyank Chauhan, Juan Lemos Ramirez, German Giese
In the emergency department, she presented with fevers (38.3 ⁰C) and tachycardia (117). Significant right abdominal and costovertebral angle tenderness were present on the exam. Complete blood count showed mild leukocytosis (11.4). Urinalysis showed rare bacteria with negative leukocyte esterase, and urine culture was negative. CT abdomen/pelvis with contrast showed enlarged right kidney with a 4 cm renal cyst, as well as a complicated right-sided perinephric fluid collection, suspicious for abscess or hematoma (Figure 1). She was admitted for sepsis and started on cefepime and vancomycin. A percutaneous drain was placed into the renal cyst, and purulent fluid was removed. Cultures of the drained fluid grew Lactobacillus, Streptococcus viridans species, and ‘mixed anaerobes’. Blood cultures grew Lactobacillus jensenii on anaerobic media. This was confirmed by both rapid ANA sequencing and MALDI-TOF Mass Spectrometry.
Adult minimal change disease with acute kidney injury: a case report and literature review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
P. Daniel Nicholas, Ian Garrahy
Physical exam revealed bilateral wheezes and lower extremity pitting edema. Laboratory studies were significant for creatinine of 1.69 mg/dL, which continued to climb despite furosemide diuresis. Albumin was 1.9 g/dL, liver function tests and lipid panel were both normal. Urinalysis showed nephrotic-range proteinuria with urine protein/creatinine ratio 5.41, 13 RBC/HPF, 10 WBC/HPF, and granular and hyaline casts. Ultrasound revealed a left renal cyst. Echocardiogram was unremarkable. Further serologic studies including viral hepatitis panel, HIV Ag/Ab, ANA, ANCA, and urinary eosinophils were negative. C3/C4 were normal. SPEP revealed hypogammaglobulinemia. Phospholipase A2 Receptor antibodies were negative.
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