EURORAD ESR

Case 10200

Nephro-cutaneous fistula

Author(s)
Tonolini Massimo, MD; Resta Federico, MD; Bianco Roberto, MD.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
female, 45 year(s)
 
 
  • Figure 1
    (Five years earlier) abdominal radiograph and unenhanced CT
     

    Supine plain abdominal radiograph discloses left-sided "staghorn" calcific nephrolithiasis (arrows).

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: Plain radiographic studies; Procedure: Lithotripsy; Special Focus: Calcifications / Calculi;

    Unenhanced CT images (b,c) confirm hyperdense "staghorn" lithiasis of left renal pelvis and upper calyces. Incidental finding of 1-cm maximum transverse diameter perirenal lymph node (arrowhead). No accessory signs...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Lithotripsy; Special Focus: Calcifications / Calculi;

    Unenhanced CT images (b,c) confirm hyperdense "staghorn" lithiasis of left renal pelvis and upper calyces. Incidental finding of 1-cm maximum transverse diameter perirenal lymph node (arrowhead). No accessory signs...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Lithotripsy; Special Focus: Calcifications / Calculi;
     
     
  • Figure 2
    (A few months later) CT-urography
     

    Excretory phase volumetric CT acquisition with multiplanar reformations confirm left "staghorn" nephrolithiasis. Both kidney show normal size, parenchymal thickness, and function.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Lithotripsy; Special Focus: Calcifications / Calculi;

    Excretory phase volumetric CT acquisition with multiplanar reformations confirm left "staghorn" nephrolithiasis. Well-opacified, patent and non-dilated excretory systems.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Lithotripsy; Special Focus: Calcifications / Calculi;

    Excretory phase volumetric CT acquisition with multiplanar reformations confirm left "staghorn" nephrolithiasis. Both kidney show normal size, parenchymal thickness, and function.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Lithotripsy; Special Focus: Calcifications / Calculi;

    Excretory phase volumetric CT acquisition with multiplanar reformations confirm left "staghorn" nephrolithiasis. Stable centimetric perirenal lymph node (arrowhead). Both kidney show normal size, parenchymal...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Lithotripsy; Special Focus: Calcifications / Calculi;
     
     
  • Figure 3
    (Current, preoperative) unenhanced and contrast-enhanced multidetector CT
     

    Unenhanced image detects appearance of left-sided hydronephrosis with mild inflammatory perirenal fat stranding and fascial thickening (*), thickened collecting system wall (arrows), increased (at least 3, the largest...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Lithotripsy; Special Focus: Infection;

    Post-contrast images confirm left-sided hydronephrosis with reduced parenchymal thickness, thickened enhancing collecting system wall (arrows), residual lower pole lithiasis, increased (at least 3, the largest 1.5 cm...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Lithotripsy; Special Focus: Infection;

    Post-contrast images confirm left-sided hydronephrosis with reduced parenchymal thickness, thickened enhancing collecting system wall (arrows), residual lower pole lithiasis, increased (at least 3, the largest 1.5 cm...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Lithotripsy; Special Focus: Infection;

    Post-contrast images confirm left-sided hydronephrosis with reduced parenchymal thickness, thickened enhancing collecting system wall (arrows), residual lower pole lithiasis, increased (at least 3, the largest 1.5 cm...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Lithotripsy; Special Focus: Infection;

    Post-contrast images confirm left-sided hydronephrosis with reduced parenchymal thickness, thickened enhancing collecting system wall (arrows), residual lower pole lithiasis, increased (at least 3, the largest 1.5 cm...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Lithotripsy; Special Focus: Infection;

    Oblique sagittal reformations (f,g) and axial images (h,i) show the longitudinal extent of severe, enhancing ureteropelvic mural thickening (arrows), with some calcific fragments in the mid-ureter.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Lithotripsy; Special Focus: Infection;

    Oblique sagittal reformations (f,g) and axial images (h,i) show the longitudinal extent of severe, enhancing ureteropelvic mural thickening (arrows), with some calcific fragments in the mid-ureter.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Lithotripsy; Special Focus: Infection;

    A thin, fluidlike track with enhancing walls consistent with clinical diagnosis of nephrocutaneous fistula (arrowheads) can be tracked through the posterior pararenal fat, quadratus muscle, and subcutaneous tissue, to...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Lithotripsy; Special Focus: Infection;
     
     
Supine plain abdominal radiograph discloses left-sided "staghorn" calcific nephrolithiasis (arrows).
 
Unenhanced CT images (b,c) confirm hyperdense "staghorn" lithiasis of left renal pelvis and upper calyces. Incidental finding of 1-cm maximum transverse diameter perirenal lymph node (arrowhead). No accessory signs indicating acute renal colic.
 
Unenhanced CT images (b,c) confirm hyperdense "staghorn" lithiasis of left renal pelvis and upper calyces. Incidental finding of 1-cm maximum transverse diameter perirenal lymph node (arrowhead). No accessory signs indicating acute renal colic.
 
Excretory phase volumetric CT acquisition with multiplanar reformations confirm left "staghorn" nephrolithiasis. Both kidney show normal size, parenchymal thickness, and function.
 
Excretory phase volumetric CT acquisition with multiplanar reformations confirm left "staghorn" nephrolithiasis. Well-opacified, patent and non-dilated excretory systems.
 
Excretory phase volumetric CT acquisition with multiplanar reformations confirm left "staghorn" nephrolithiasis. Both kidney show normal size, parenchymal thickness, and function.
 
Excretory phase volumetric CT acquisition with multiplanar reformations confirm left "staghorn" nephrolithiasis. Stable centimetric perirenal lymph node (arrowhead). Both kidney show normal size, parenchymal thickness, and function.
 
Unenhanced image detects appearance of left-sided hydronephrosis with mild inflammatory perirenal fat stranding and fascial thickening (*), thickened collecting system wall (arrows), increased (at least 3, the largest 1.4 cm transverse diameter) lymphadenopathies (arrowheads).
 
Post-contrast images confirm left-sided hydronephrosis with reduced parenchymal thickness, thickened enhancing collecting system wall (arrows), residual lower pole lithiasis, increased (at least 3, the largest 1.5 cm maximum transverse diameter) lymphadenopathies (arrowheads).
 
Post-contrast images confirm left-sided hydronephrosis with reduced parenchymal thickness, thickened enhancing collecting system wall (arrows), residual lower pole lithiasis, increased (at least 3, the largest 1.5 cm maximum transverse diameter) lymphadenopathies (arrowheads).
 
Post-contrast images confirm left-sided hydronephrosis with reduced parenchymal thickness, thickened enhancing collecting system wall (arrows), residual lower pole lithiasis, increased (at least 3, the largest 1.5 cm maximum transverse diameter) lymphadenopathies (arrowheads).
 
Post-contrast images confirm left-sided hydronephrosis with reduced parenchymal thickness, thickened enhancing collecting system wall (arrows), residual lower pole lithiasis, increased (at least 3, the largest 1.5 cm maximum transverse diameter) lymphadenopathies (arrowheads).
 
Oblique sagittal reformations (f,g) and axial images (h,i) show the longitudinal extent of severe, enhancing ureteropelvic mural thickening (arrows), with some calcific fragments in the mid-ureter.
 
Oblique sagittal reformations (f,g) and axial images (h,i) show the longitudinal extent of severe, enhancing ureteropelvic mural thickening (arrows), with some calcific fragments in the mid-ureter.
 
A thin, fluidlike track with enhancing walls consistent with clinical diagnosis of nephrocutaneous fistula (arrowheads) can be tracked through the posterior pararenal fat, quadratus muscle, and subcutaneous tissue, to the skin.
 
 
 
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