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Perinephric Abscess

Abscess Perirenal


Presentation

  • We report an unusual presentation of a pancreatic pseudocyst in a young male who presented with a left perinephric abscess.[ncbi.nlm.nih.gov]
  • We present a first case report in which a PA fistualized with the descending colon following percutaneous drainage.[ncbi.nlm.nih.gov]
  • A case of perinephric abscess with renal cell carcinoma is presented. Hematuria is uncommon in cases of perinephric abscess.[ncbi.nlm.nih.gov]
  • Abdominal aortic aneurysms of any cause are rarely seen in the childhood age group and present most frequently in adults. An infant is presented who developed a mycotic abdominal aortic aneurysm secondary to a large perinephric abscess.[ncbi.nlm.nih.gov]
  • A case of nephrolithiasis complicated by obstruction leading to pyonephrosis, perinephric abscess, and nephrobronchial fistula is presented.[ncbi.nlm.nih.gov]
Fever
  • Fever was documented before diagnosis in 88% of patients. Abdominal mass (13%) or tenderness (49%), and flank mass (9%) or tenderness (42%) were seen less frequently, and 11% of patients did not have fever, flank, or abdominal findings.[ncbi.nlm.nih.gov]
  • Four months after the transplant, the patient was admitted for perirenal allograft pain, fever, and elevated inflammatory parameters and liver enzyme levels. A renal ultrasonography found a collection of fluid.[ncbi.nlm.nih.gov]
  • A 6-year-old girl had lower abdominal pain for 3 days and high fever on the day of admission.[ncbi.nlm.nih.gov]
  • After 10 days of antibiotics, abdominal paracentesis was repeated because of recurrence of fever; E. coli peritonitis was confirmed. Subsequent autopsy revealed a perinephric abscess.[ncbi.nlm.nih.gov]
  • Masurol, in writing of intermittent fever, several years ago, indicates it well.[books.google.com]
Chills
  • Other risk factors for perirenal abscess include: Diabetes Having an abnormal urinary tract Trauma Symptoms Symptoms of perirenal abscess include: Chills Fever Pain in the flank (side of the abdomen) or abdomen, which may extend to the groin or down the[dxline.info]
  • Fever (55%), chills or diaphoresis (47%), flank pain (40%), abdominal pain (40%), and nausea or vomiting (32%) were the most common presenting symptoms. About half the patients had symptoms for 1 week or less and 12% had no symptoms.[ncbi.nlm.nih.gov]
  • Other risk factors for perirenal abscess include: Diabetes Having an abnormal urinary tract Trauma IV drug use Symptoms of perirenal abscess include: Chills Fever Pain in the flank (side of the abdomen) or abdomen , which may extend to the groin or down[medlineplus.gov]
  • The following case represents an unusual localization of infection with this organism.A 37-year-old married man had pain in the left flank for two weeks and shaking chills for three days.[nejm.org]
Malaise
  • Diabetes mellitus, fever, malaise and pain in the left flank.Left hydronephrosis secondary to obstruction by proximal ureteral calculi.[slideshare.net]
  • Patients, typically middle-aged /elderly males, present with non-specific symptoms, such as fever , malaise , and weight loss. Right upper quadrant pain and tender hepatomegaly are specific features of a liver abscess but are often absent.[amboss.com]
  • Synonym: cerebral abscess ; intracranial abscess Symptoms Symptoms may include headache, fever, vomiting, malaise, irritability, seizures, or paralysis. Treatment The usual treatment is chemotherapy.[medical-dictionary.thefreedictionary.com]
  • Malaise, nausea, vomiting, anorexia and occasionally diarrhoea occur. There may or may not be accompanying lower urinary tract symptoms with frequency, dysuria, gross haematuria or hesitancy.[patient.info]
  • Constitutional symptoms : chills , malaise , anorexia and weight loss . Abdominal pain : Not localized due to the unusual site of the abscess .[wikidoc.org]
Flank Mass
  • Abdominal mass (13%) or tenderness (49%), and flank mass (9%) or tenderness (42%) were seen less frequently, and 11% of patients did not have fever, flank, or abdominal findings.[ncbi.nlm.nih.gov]
  • A flank mass is palpable if the abscess is large or located in the inferior pole of the kidney space (9-47%). A renal malignancy must be ruled out in these patients with appropriate radiographic studies (eg, CT scanning, MRI).[emedicine.medscape.com]
Abdominal Pain
  • Despite immunosuppression, signs and symptoms of perinephric abscess were prominent and included fever, flank and abdominal pain and tenderness, and abdominal mass.[ncbi.nlm.nih.gov]
  • A 6-year-old girl had lower abdominal pain for 3 days and high fever on the day of admission.[ncbi.nlm.nih.gov]
  • Fever (55%), chills or diaphoresis (47%), flank pain (40%), abdominal pain (40%), and nausea or vomiting (32%) were the most common presenting symptoms. About half the patients had symptoms for 1 week or less and 12% had no symptoms.[ncbi.nlm.nih.gov]
  • Consideration of this diagnosis should enter into the differential diagnosis of fever with abdominal pain or flank pain.[ncbi.nlm.nih.gov]
  • When to Contact a Medical Professional Call your health care provider if you have a history of kidney stones and develop: Abdominal pain Burning with urination Chills Fever Urinary tract infection Prevention If you have kidney stones, ask your doctor[dxline.info]
Right Flank Pain
  • A 3-year-old girl presented with high fever and right flank pain for more than 1 week. Ultrasonography showed a right perinephric fluid collection with normal renal parenchyma and collecting system.[ncbi.nlm.nih.gov]
  • A 53-year-old Chinese premenopausal woman presented with intermittent right flank pain for many years. Imaging studies revealed a contracted non-functioning right kidney and a perinephric abscess.[ncbi.nlm.nih.gov]
  • A 69-yr-old woman presented to our emergency room with severe right flank pain that had developed one week earlier. She also complained of anuria for three days.[synapse.koreamed.org]
  • flank pain, tactile fever, chills, nausea, anorexia, and a single episode of hematuria.[aafp.org]
Right Flank Pain
  • A 3-year-old girl presented with high fever and right flank pain for more than 1 week. Ultrasonography showed a right perinephric fluid collection with normal renal parenchyma and collecting system.[ncbi.nlm.nih.gov]
  • A 53-year-old Chinese premenopausal woman presented with intermittent right flank pain for many years. Imaging studies revealed a contracted non-functioning right kidney and a perinephric abscess.[ncbi.nlm.nih.gov]
  • A 69-yr-old woman presented to our emergency room with severe right flank pain that had developed one week earlier. She also complained of anuria for three days.[synapse.koreamed.org]
  • flank pain, tactile fever, chills, nausea, anorexia, and a single episode of hematuria.[aafp.org]
Abdominal Mass
  • Despite immunosuppression, signs and symptoms of perinephric abscess were prominent and included fever, flank and abdominal pain and tenderness, and abdominal mass.[ncbi.nlm.nih.gov]
  • Abdominal mass (13%) or tenderness (49%), and flank mass (9%) or tenderness (42%) were seen less frequently, and 11% of patients did not have fever, flank, or abdominal findings.[ncbi.nlm.nih.gov]
  • A palpable flank or abdominal mass is present in about half of the cases. The mass may be better appreciated by examination of the patient in the knee–chest position. There may also be signs of psoas muscle irritation with flexion of the thigh.[urologysurgery.wordpress.com]
Left Flank Pain
  • Case Report A 43-year-old female, with left renal stone, presented to our hospital after two days of fever and left flank pain.[ijcasereportsandimages.com]
Tachycardia
  • Physical exam for both acute pyelonephritis and perinephric abscess is usually positive for the following: fever, tachycardia, tenderness over the costoverterbral angles and abdomen on deep palpation.[clinicaladvisor.com]
  • Symptoms of Renal Abscess Weight loss Discomfort Specific Symptoms of Renal Abscess Fever with chills Uncontrollable shaking or shivering Temperature- 112 to 104 0 F Excessive Sweating Abdominal Pain Painful Urination Bloody Urine Hypotension Pale Skin Tachycardia[epainassist.com]
  • In advanced cases with septicemia , the patient may be drowsy with decreased level of consciousness . [1] Vital signs Fever Tachycardia Tachypnea Hypotension (if patient is presenting with shock ) Abdominal Examination Abdominal tenderness is often present[wikidoc.org]
  • Signs of sepsis (eg, tachypnoea, tachycardia, hypotension). Dehydration or inability to take fluids/medication. Severe pain or debility. Failure of response to treatment in primary care within 24 hours. [ 8 ] Urinary tract obstruction.[patient.info]
  • The initial evaluation revealed high fever (body temperature 39.7 C), tachycardia (heart rate, 112 beats per minute), leukocytosis (white blood cell, 24,560 per micrometer) with a left shift of elevated C-reactive protein (18.98 mg/dL), and left flank[ijcasereportsandimages.com]
Ecthyma
  • Persistent bacteremia resulted in the development of ecthyma gangrenosum, which has not previously been associated with Klebsiella spp infection.[ncbi.nlm.nih.gov]
Vesicular Rash
  • On day 12 a vesicular rash appeared on the neck and herpes simplex virus 1 (HSV-1) grew on culture. On day 15 an upper leg collection was seen on CT scan.[ncbi.nlm.nih.gov]
Agalactia
  • We describe the case of a 37 year-old diabetic woman who presented with a multiloculated perinephric abscess caused by Streptococcus agalactiae 12 months after receiving a living-related kidney graft.[ncbi.nlm.nih.gov]
  • Streptococcus agalactiae (Group B Streptococcus). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and practice of infectious diseases. 5th ed. Philadelphia: Churchill Livingston, 2000:2156–67. ... 2.[aafp.org]
  • Three cases were caused by Alcaligenes faecalis , Staphylococcus saprophyticus , or Streptococcus agalactiae , respectively.[kjim.org]
Neglect
  • Ng E, Rossiter SB, Reimer GW: Renal puncture: a neglected aid in the diagnosis of renal masses. West J Med 104 :102–105, 1966 Google Scholar 5. Smith EH, Bartrum RJ Jr: Ultrasonically guided percutaneous aspiration of abscesses.[link.springer.com]
Flank Pain
  • Perinephric abscesses often present with flank pain and signs of sepsis, and are known to discharge to the skin.[ncbi.nlm.nih.gov]
  • A 3-year-old girl presented with high fever and right flank pain for more than 1 week. Ultrasonography showed a right perinephric fluid collection with normal renal parenchyma and collecting system.[ncbi.nlm.nih.gov]
  • A 53-year-old Chinese premenopausal woman presented with intermittent right flank pain for many years. Imaging studies revealed a contracted non-functioning right kidney and a perinephric abscess.[ncbi.nlm.nih.gov]
  • Fever (55%), chills or diaphoresis (47%), flank pain (40%), abdominal pain (40%), and nausea or vomiting (32%) were the most common presenting symptoms. About half the patients had symptoms for 1 week or less and 12% had no symptoms.[ncbi.nlm.nih.gov]
  • Consideration of this diagnosis should enter into the differential diagnosis of fever with abdominal pain or flank pain.[ncbi.nlm.nih.gov]

Workup

  • Initial ED diagnostic workup included a hemogram that showed marked leukocytosis with neutrophilia (WBC: 36,100/mm 3 and ANC: 20,700/mm 3 ) and normocytic, hypochromic anemia (hemoglobin 9.1 g/dL, MCV 64 and MCH 21).[healio.com]
Pericardial Effusion
  • Her hospital course was complicated with empyema, peritonitis, and pericardial effusion. A 6-year-old girl had lower abdominal pain for 3 days and high fever on the day of admission.[ncbi.nlm.nih.gov]
Pulmonary Infiltrate
  • Nephrobronchial fistula, while a rare complication of perinephric abscess, should be considered when a patient presents with perirenal suppurative process and chest x-ray findings consistent with pleural effusion or pulmonary infiltrates.[ncbi.nlm.nih.gov]

Treatment

  • Treatment utilized both percutaneous drainage and open surgery. Perinephric abscesses have not been previously reported to extend into the spleen.[ncbi.nlm.nih.gov]
  • Cost for treatment Diagnostic tests for perinephric abscess Perinephric abscess treatment with open surgery drainage Perinephric abscess treatment with percutaneous drainage University Hospital of Ludwig Maximilian University of Munich 10 / 10 from 40[bookinghealth.com]
  • The treatment of acute pyelonephritis can be divided into inpatient and outpatient treatment.[clinicaladvisor.com]
  • Treatment consists of surgery and systemic antifungal therapy. The recent antifungal agent, ketoconazole, is discussed.[ncbi.nlm.nih.gov]
  • Following correct diagnosis and drainage, a definitive treatment was carried out to drain the intrarenal abscess laparoscopically.[ncbi.nlm.nih.gov]

Prognosis

  • Treatment and prognosis Perinephric and mixed perinephric/renal abscesses are typically treated with imaged guided percutaneous drainage.[radiopaedia.org]
  • (Outcomes/Resolutions) In most cases, an immediate diagnosis and suitable treatment of Perirenal Abscess will result in good prognosis Any case of kidney stones must be treated promptly, because it is the biggest risk factor that may lead to Perirenal[dovemed.com]
  • Outlook (Prognosis) In general, quick diagnosis and treatment of perirenal abscess should lead to a good outcome. Kidney stones must be treated to avoid further infections.[dxline.info]
  • Twelve months after surgery the dog remains clinically stable, but owing to the disease of its remaining kidney its long-term prognosis is poor.[veterinaryrecord.bmj.com]
  • Symptoms and imaging techniques, such as computed tomography (CT), magnetic resonance imaging (MRI) and renal ultrasound (US) of higher quality have led to an early diagnosis that is very important for patients’ prognosis.[urologiajournal.com]

Etiology

  • Herein we review 26 cases of perinephric abscess, analyzed according to incidence, etiology, laboratory findings, signs and symptoms, diagnosis, radiographic findings, operative procedures, mortality and associated diseases.[ncbi.nlm.nih.gov]
  • Candida and Torulopsis species are the reported etiologic agents. Successful therapy usually consists of percutaneous or surgical drainage of the abscess.[ncbi.nlm.nih.gov]
  • Examination of a fresh smear of pus may be critically important in the diagnosis of closed-space infections of unknown etiology.[ncbi.nlm.nih.gov]
  • This case report indicates that any patient presenting with a perinephric abscess of unknown etiology not responding to conventional treatment modalities should be investigated for underlying pancreatitis.[ncbi.nlm.nih.gov]
  • Examination of a fresh smear of pus may be critically important in the diagnosis of closed-space infections of unknown etiology. Copyright 1975 by The American Society of Tropical Medicine and Hygiene Article metrics loading...[ajtmh.org]

Epidemiology

  • Clinical, epidemiological, and microbiological profile of patients with vancomycin-resistant enterococc from a tertiary care hospital. J Glob Infect Dis 2012;4:137-8. 3. Saadat S, Solhjoo K, Norooz-Nejad MJ, Kazem A.[jacmjournal.org]
  • Epidemiology References: [1] [2] [3] [4] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Epidemiology and infection. 139(2):229-35. 2011. [ pubmed ] Coelho RF, Schneider-Monteiro ED, Mesquita JL, Mazzucchi E, Marmo Lucon A, Srougi M. Renal and perinephric abscesses: analysis of 65 consecutive cases.[ultrasoundoftheweek.com]
  • Epidemiology Frequency Perinephric abscess is an uncommon complication of urinary tract infections. The incidence ranges from 1-10 cases for every 10,000 hospital admissions. Men and women are affected with equal frequency.[emedicine.medscape.com]
  • […] tract ) Multibacterial & anaerobes (if gastrointestinal tract (GIT) is the primary source) Staphylococcus aureus (if from distant septic focus ) Tuberculosis (if secondary to Pott’s disease ) Differentiating retroperitoneal abscess from other Diseases Epidemiology[wikidoc.org]
Sex distribution
Age distribution

Pathophysiology

  • We review similar cases in the literature and discuss pathophysiology and current management of perinephric abscesses.[ncbi.nlm.nih.gov]
  • Each highly focussed chapter is written by a leader in the field and covers relevant pathophysiology, diagnosis, treatment and prevention.[books.google.ro]
  • Brenner/Rector remains the go-to resource for practicing and training nephrologists and internists who wish to master basic science, pathophysiology, and clinical best practices.[books.google.com]
  • Leukocytosis is usually not extremely high (between 10,000 and 20,000 in most cases) Blood culture is not always positive (but carries a grave prognosis if positive).Organism depends on the source of abscess as mentioned above in pathophysiology.[wikidoc.org]

Prevention

  • Since the extent of the disease may not be apparent radiologically, and often is only ascertained at the time of surgery, we recommend an aggressive approach to renal calculi as the most effective means of preventing complicated perinephritis.[ncbi.nlm.nih.gov]
  • Possible mechanisms and preventative measures are discussed.[ncbi.nlm.nih.gov]
  • Early diagnosis might have prevented an unnecessary nephrectomy in cases of uncomplicated renal endometriosis.[ncbi.nlm.nih.gov]
  • Each highly focussed chapter is written by a leader in the field and covers relevant pathophysiology, diagnosis, treatment and prevention.[books.google.ro]

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