Renal abscesses

Preschooler

with febrile seizure and abdominal pain. Axial (left upper) and coronal (right upper) CT with contrast of the abdomen shows a round low density lesion in the lower pole of the left kidney. Transverse (lower left) and sagittal (lower right) color doppler US of the the left kidney shows the round lesion in the lower pole to be solid and avascular in nature.The diagnosis was renal abscess.

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Teenager who

had thoracic surgery a week ago and now has sepsis. Coronal T1 MRI with contrast of the brain (above) shows multiple small enhancing lesions in the brain and one large ring enhancing lesion in the right hemisphere of the brain. Coronal CT with contrast of the abdomen (below) shows multiple peripheral low density wedge shaped lesions in the spleen and both kidneys. The diagnosis was infective endocarditis leading to cerebral abscess and splenic abscess and renal abscess.

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Renal abscess, is a collection of infective fluid in the kidney. It is usually a sequela of acute pyelonephritis, where severe vasospasm and inflammation may occasionally result in liquefactive necrosis and abscess formation.

Epidemiology

It can affect all ages and has no recognized gender predilection.

Risk factors

The predisposing factors include :

diabetes mellitus
renal calculi
ureteral obstruction

Clinical presentation

The most common signs or symptoms are:

fever
flank/abdominal pain
chills
dysuria

Radiographic features

Ultrasound

Typically, a renal abscess appears as a well-defined hypoechoic area within the cortex or in the corticomedullary parenchyma. It demonstrates internal echoes within and an associated diffusely hypoechoic kidney due to acute pyelonephritis may be seen. Perinephric collection may also be seen.

CT

CT is currently the most accurate modality for diagnosis and follow-up of renal abscesses . An abscess appears as a well-defined mass of low attenuation with a thick, irregular wall or pseudo capsule, which can be better visualized on contrast enhanced scans. Gas within a low attenuation/cystic mass strongly suggests abscess formation. Renal parenchyma around the abscess cavity may appear hypoenhancing in nephrogram phase, and may appear hyperattenuating in delayed images. Associated fascial and septal thickening is seen with obliteration of perinephric fat.

In some cases, the formation of a discrete abscess is preceded by acute focal lobar nephronia which is a focal inflammation of the kidney without liquefaction. It appears as a solid mass.