Retroperitoneal abszedierende Aktinomykose nach urogynäkologischer Voroperation

Human actinomycosis is an infrequent chronic infection caused by gram-positive anaerobic bacteria with predominantly cervicofacial and intestinal manifestation. Retroperitoneal abscess formation displays a very rare localisation and is mostly incidentally diagnosed by histological examination. We report on a 44-year-old woman with left-sided flank pain and retroperitoneal abscess formation diagnosed by CT scan. Case history revealed preceding nephroureterectomy of the left kidney due to loss of kidney function and recurrent ureteral-vaginal fistulas. After CT scan-guided puncture and negative bacterial culture, actinomycosis could only be diagnosed by histopathological examination. Subsequently, besides abscess drainage calculated antibiotic therapeutic regimen was initiated. During the follow-up of 9 months there was no local or systemic recurrence. In the present case report, aetiology, clinical symptoms as well as diagnostic and therapeutic consequences are discussed.     

Two cases of leiomyoma of the kidney]

Renal leiomyomas large enough to be clinically diagnosed are extremely rare. We review 30 cases of clinically diagnosed renal leiomyoma from the literature in Japan, including our 2 new cases. Case 1: In a 52-year-old man with no symptoms a renal mass was found accidentally on an ultrasonogram. CT scan showed a mass with a cystic area at the upper pole of the right kidney. Angiogram showed a hypovascular mass. Case 2: CT scan revealed a cystic mass and angiogram showed an avascular mass at the upper pole of the left kidney in a 19-year-old man having gross hematuria and left flank pain. Transperitoneal nephrectomy was done in both cases. Histologically each tumor was composed of monotonous proliferation of spindle shaped cells without atypia, which showed intense immunoreactivity for alpha-smooth muscle actin. The diagnosis of benign leiomyoma was made in each case. In a review of 30 cases, we found that renal leiomyomas occur most often in female (77%), between decades 2 and 5 of life (median: 46 years). On the angiogram it appears most often as an avascular or hypovascular mass. CT scan shows cystic or mixed solid/cystic or solid lesion, occasionally with calcification. Preoperative diagnosis is extremely difficult to be made. Histologically, fibroma, angiomyolipoma, congenital mesoblastic nephroma and leiomyosarcoma should be differentiated.     

Diagnosis and treatment of renal angiomyolipoma

We have hitherto reported 6 cases of renal angiomyolipoma. Recently, we encountered two more such cases. Case 1 is a 34-year-old woman with fever as the chief complaint. DIP revealed a tumor mass in the right upper pelvic pole. This mass showed a strong echo level on ECHO and adipose tissue of low density on CT scan. Therefore, the patient was diagnosed as having renal angiomyolipoma. Since liposarcoma was not ruled out by the examination of frozen sections during operation, nephrectomy was performed. Case 2 is a 40-year-old woman. Diagnosed as having bilateral renal angiomyolipoma, she underwent right nephrectomy 14 years ago. Two years ago, she had heavy hematuria, and had embolization of the left renal artery. She has had no bleeding since the embolization. We are of the view that ECHO and CT can are very useful for diagnosis of renal angiomyolipoma, and embolization for heavy hematuria, a complication, should be performed first of all.     

Right perinephric abscess: a rare presentation of ruptured retrocecal appendicitis

Perinephric abscess commonly arises from rup- ture of an intrarenal abscess into the perinephric space. It rarely results from gastrointestinal pathology. We report two pediatric patients with retrocecal appendicitis that presented with perinephric abscess. 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. A perinephric abscess extending from a ruptured retrocecal appendix was diagnosed by ab-dominal computed tomographic (CT) scan. 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. Ultrasonography showed a right perinephric abscess with a normal renal contour and a fecalith in the enlarged appendix in the right lower quadrant of the abdomen. Appendectomy and drainage of the perinephric abscess were performed in both cases. We suggest that a ruptured retrocecal appendix must be considered in cases of perinephric abscess, especially in patients with gas bubbles in the abscess and a normal urogenital appearance. Ultrasonography and abdominal CT scan are the preferred diagnostic tools. Prolonged antibiotics and drainage of the abscess are mandatory to decrease morbidity and mortality. Received: 30 August 2001 / Reviesd: 15 November 2001 / Accepted: 17 November 2001     

Abscess of corpus cavernosum: two case reports

Case 1: A 50-year-old man was admitted to our hospital complaining of miction pain and fever up. Although there was remission by antibiotic treatment, symptoms recurred. Computed tomographic scan revealed swelling of scrotum and penis. Therefore, the patient was diagnosed with abscess of corpus cavernosum. The patient underwent debridement. Although symptoms remissed, he had erectile dysfunction. Case 2: A70-year-old man was admitted to our hospital complaining of perineal painful swelling. The patient was diagnosed with abscess of corpus cavernosum by computed tomographic scan. The patient underwent debridement, and symptoms remissed. If the patient is admitted to hospital complaining of miction pain and fever up, abscess of corpus cavernosum should be suspected.     

不典型肾错构瘤的诊断与治疗（附18例报告）

目的：探讨不典型肾错构瘤的误诊原因,提高其诊治水平。方法：回顾性分析18例不典型肾错构瘤的临床资料。18例均行B超检查,15例行CT扫描,8例行MRI扫描,6例行IVU检查。3例接受保守治疗;15例接受手术治疗,其中3例行肿瘤剜除术,5例行肾部分切除术,7例行肾癌根治术。结果：B超诊断肾错构瘤10例（10／18）,CT诊断肾错构瘤7例（7／15）。3例保守治疗者获得随访,肿瘤大小无明显变化,无转移。15例手术治疗者术后病理检查均为肾错构瘤,随访未见肿瘤转移或复发。结论：大部分肾错构瘤可通过B超、CT等影像学检查明确诊断;对于不典型肾错构瘤,术前应仔细分析影像学检查,结合病史尽量明确诊断,减少不必要的肾切除。     

Two cases of cerebral aspergillosis with intracerebral hemorrhage

Two patients who had cerebral aspergillosis with massive intracerebral hemorrhage were presented. Case I was a 59-year-old woman who had slight mental retardation. There was swelling in the left forehead, from which mucosal cysts of frontal sinus had been removed 2 years before her admission. She had a diagnosis of subdural abscess and radical operation was performed. Aspergillus was found in the abscess histologically. Three months after the operation, CT scan revealed multiple abscess in bilateral frontal lobe. When she lost consciousness suddenly 4 months after the operation, CT scan showed a huge intracerebral hematoma. Case 2 was a 16-year-old girl who suffered from immunological dysfunction caused by more than 6 months antibiotics-steroid treatment for pneumonitis. She lost her consciousness after complaints of severe headache. CT scan showed a heterogeneous high density area with severe brain edema in the left temporal lobe. The removal of hematoma was performed immediately. The level of her consciousness improved, but she died of the complication of DIC and renal failure 14 days after the hemorrhage. Autopsy revealed a number of aspergillomas in lungs, kidneys, gastrointestinal tract, liver and pancreas. Marked necrosis and a number of aspergillus hyphae which invaded and penetrated the wall of cerebral vessels were found in the brain tissue. It was presumed that such a huge intracerebral hematoma was caused by direct invasion and penetration into the brain of aspergillus from the blood vessels. The diagnosis of cerebral aspergillosis is made mainly by the pathological examination of the tissue obtained at surgery or autopsy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Selective operative management of major blunt renal trauma

BACKGROUND: We reviewed the management and outcomes of patients at our Level I trauma center suffering major blunt renal trauma diagnosed and staged by CT scan. METHODS: We retrospectively reviewed the cases of 26 patients with blunt trauma at our institution who were initially hemodynamically stable and diagnosed with grade 4 or 5 renal injuries by CT scan. Patients were broken down into two groups based on whether they were managed conservatively or surgically. Patient characteristics and morbidity were analyzed. RESULTS: There were 14 patients managed conservatively and 12 patients managed surgically. There was no statistically significant difference in morbidity between the two groups. The only statistically significant predictor of failure of conservative management was a coexisting solid organ intra-abdominal injury. CONCLUSIONS: Conservative management of major blunt renal trauma is appropriate in hemodynamically stable patients.     

Acute diffuse bacterial nephritis in horse shoe kidney

Horseshoe kidney is a congenital malformation which predisposes the patient to severe urinary tract infections, due to pelvic ectasia which is inherent in the malrotation of the renal units. Acute bacterial nephritis is an evolutionary stage of the acute renal infection situated between acute pyelonephritis and renal abscess. It is only possible to carry out a differential diagnosis of these two bodies through the application of some imaging technique, as it is impossible to differentiate them from a clinical point of view. A CT contrast scan is the most sensitive and specific means of diagnosing acute bacterial nephritis, and is considered to be the most appropriate test method. The CT scan usually reveals circular or wedge-shaped cortical areas which become striated after contrast administration. Treatment is based on broad-spectrum antibiotherapy, which must be continued for a period of 3 to 6 weeks. We present a case of diffuse acute bacterial nephritis, occurring in a paediatric patient with a horseshoe kidney, which was successfully treated by means of a prolonged course of antibiotics.     

Sensitivity of computed tomography in detection of perirectal abscess

Most patients with anorectal abscess are diagnosed clinically based on pain, erythema, warmth, and fluctuance. Some patients, however, present with subtle or atypical signs. CT is easily accessible and is commonly used for diagnosis and delineation of anorectal abscess. The purpose of this study is to determine the sensitivity of CT scan in detecting perirectal abscesses and to see if immune status impacts the accuracy of CT. A retrospective study was conducted to identify patients from 2000 to 2009 with International Classification of Diseases, 9th Revision code 566 (anal or rectal abscess). Patients included had a CT scan less than 48 hours before drainage. Patients with CT-positive abscess were compared with patients with CT-negative abscess. Patients were categorized as either immunocompetent or immunosuppressed based on documentation of diabetes mellitus, cancer, human immunodeficiency virus, or end-stage renal disease. One hundred thirteen patients were included in this study. Seventy-four (65.5%) were male and the average age was 47 years. Eighty-seven of 113 (77%) patients were positive on CT for anorectal abscess. Sixty of 113 (53%) patients included in this study were immunocompromised. CT missed 26 of 113 (23%) patients with confirmed perirectal abscess. Eighteen (69%) of these patients were immunocompromised compared with CT-positive patients (42 [48%], P = 0.05). The overall sensitivity of CT in identifying abscess was 77 per cent. CT lacks sensitivity in detecting perirectal abscess, particularly in the immunocompromised patient.     

Solitary infected renal cyst: report of 2 cases and review of literature.

Two cases of suppuration in solitary renal cyst are reported. The clinical history of acute pyelonephritis, avascular mass lesion of the kidney with ipsilateral pleural effusion (triad) seen in a female patient of child-bearing age is characteristic of this condition. Surgical management is satisfactory. Our Case 1 is the first reported case of solitary infected cyst that ruptured retroperitoneally, clinically mimicking a subphrenic abscess.     

Infected solitary renal cyst extending to subphrenic abscess--a case study and review of the literature

A 54-year-old female, who had been mediated for simple type schizophrenia for the past eleven years, was hospitalized with left lumbar discomfort or pain. After admission, the following abnormalities were apparent serologically; leucocytosis of 15700/mm, erythrocyte sedimentation rate of 147 mm/h, hyper alpha 2-globulinemia (675 ng/dl of haptoglobulin). Urine cultures were negative. Left renal simple cyst with infection was evaluated by intravenous urography, ultrasonogram, computed tomographic (CT) scan., and renal angiogram. In addition, left subphrenic abscess behind the spleen, which had to be penetrated through retroperitoneum, could be diagnosed. So, in our case, cystic wall resection (unroofing) and/or conservatively percutaneous cystotomy for pus drainage were all not indicated instead of radical operation for abscess removal completely. CT scan is mostly available to make differential diagnosis whether the infectious renal cyst influence to the neighbouring organs beyond the renal capsule, or not. Here, we discussed the pathogenesis on the infection of solitary renal cyst, and some problems reported in the literature.     

Gas-forming infections in genitourinary tract.

Diabetes mellitus associated with urinary tract infections and ureteral obstruction can be predisposing factors leading to emphysematous pyelonephritis. Fever, flank pains, and a palpable renal mass, associated with dehydration and hyperglycemia, were the most frequent presenting symptoms associated with emphysematous pyelonephritis. Computerized tomography (CT) scan is the best method to identify a renal or perirenal abscess and its ramifications. Intravenous antibiotic therapy is determined by blood and urine cultures. Mortality was zero in patients treated by nephrectomy. One patient who had incision and drainage of a renal abscess died of sepsis, and 1 patient died of sepsis following incision and drainage of a prostatic abscess. Patients with cystitis emphysematosa require antibiotic therapy and relief of bladder outlet obstruction. Prostatic abscess is best treated by perineal incision and drainage. Periurethral scrotal abscesses should be incised, drained, and the overlying necrotic skin debrided. Early diagnosis and aggressive medical and surgical management of gas-forming infections of the genitourinary tract are vital.     

肾错构瘤破裂出血的诊治(附10例报告)

目的：探讨肾错构瘤破裂出血的诊断和治疗方法。方法：回顾性分析了１９９０￣１９９９年诊治的１０例肾错构瘤破裂出血患者的临床资料,９例行手术治疗,１例行保守治疗。结果：９例术后恢复良好,１例保守治疗者病情稳定。结论：Ｂ超和ＣＴ检查对诊断紧错构瘤破裂出血有帮助;对肾错构瘤的治疗应全面考虑,手术仍为主要的治疗方法。     

A case report: abscess of the cavum septi pellucidi

A rare case of an abscess in the cavum septi pellucidi (CSP) is described and previously reported cases are reviewed. A 60-year-old male was admitted to the hospital because a diagnosis of cerebellar hemisphere infarction was made on CT scan. Seven years earlier, the patient had undergone a craniotomy for aneurysm clipping, and a ventriculo-peritoneal shunt was installed for normal pressure hydrocephalus 14 days after the aneurysmal rupture. On his second hospitalization CT scan also demonstrated CSP but this was not associated with ventriculomegaly. He was placed on a rehabilitation regimen and his hospital course was uneventful. Two months later, however, he developed hyponatremia due to the syndrome of inappropriate secretion of antidiuretic hormone. After analysis of CSF obtained from the shunting device, a diagnosis of meningitis was made and CSF culture revealed E. coli infection. A part of the peritoneal tubing was torn and missing when the tube was removed from the peritoneal cavity and converted to outer drainage. Being treated with intrathecal and intravenous antibiotics administration, the meningitis subsided. However, CT scan taken twelve days after the onset of the infection showed an abscess in CSP which showed ring enhancement after contrast media. Therefore, the patient continued to receive intravenous antibiotics to counter the mass effect due to the abscess. The abscess had disappeared on follow-up CT scan obtained ten days later. The patient, however, eventually expired after iatrogenic hypernatremia associated with acute renal failure. The patient was submitted to an autopsy. The authors speculate that the abscess developed through a retrograde cisternal route after infection which had originated from bowel perforation by the peritoneal shunt tube.     

Brain abscess (Part 5)--Brain abscess following internal carotid occlusion (author's transl)]

Three cases of brain abscess following an occlusion of the internal carotid artery were reported. Case 1: A 6-year-old girl with congenital heart disease was admitted with headache, disturbance of consciousness and left hemiparesis. Right carotid angiography revealed an occlusion of the right internal carotid artery. After 6 months, she was readmitted with high fever. CT scan revealed a low density area and a ring-like shadow at the same site of cerebral infarction. Case 2: A 69-year-old man was admitted in semicoma and with right hemiplegia. Left angiography revealed an occlusion of the left internal carotid artery. After 2 months, a brain abscess was noted in the infarcted area. Case 3: A 20-year-old man with congenital heart disease, was admitted due to headache, vomiting and high fever. CT scan revealed a brain abscess in the right frontal lobe. Carotid angiography showed bilateral internal carotid artery occlusion. We concluded that diminution of cerebral oxygen and encephalomalacia are predisposing factors to the evolution of brain abscess.     

Pyogenic splenic abscess in intravenous drug addiction

Among the surgical complications of intravenous drug addiction, pyogenic splenic abscess is considered to be a rare entity. A review of the literature reveals only 24 cases of splenic abscess secondary to this particular etiology. The authors report five patients with intravenous drug addiction who underwent splenectomy for pyogenic splenic abscess within 1 year. Fever and abdominal pain were the only constant physical signs. Three patients had associated infective endocarditis, and the other two patients sustained blunt trauma to the left side of the trunk weeks earlier. Computed tomography (CT) and ultrasound were diagnostic in all five patients preoperatively, and they were complementary when combined. Four of the five patients had Staphylococcus aureus septicemia at the time of splenectomy. Three patients recovered from their operations, and the other two, both with endocarditis, died postoperatively from causes unrelated to splenic abscess and splenectomy. A high index of suspicion is warranted in this susceptible group of patients with vague abdominal signs and persistent sepsis to rule out splenic suppuration. The noninvasive imaging methods, CT scan and ultrasound, facilitate early diagnosis in these patients.     

Renal metastasis from squamous cell carcinoma of the hypopharynx

We present a rare case of metastatic renal tumor originating from squamous cell carcinoma of the hypopharynx. A 67-year-old man treated with irradiation for hypopharyngeal carcinoma was referred to our hospital with gross hematuria and a left renal mass, which was delineated as a heterogeneously enhanced mass by CT scan. Left nephrectomy was performed, and the non-encapsulated mass was gray in color macroscopically. Histological examination of the specimen revealed alveolar proliferation of small cancer cells, which was consistent with the original tumor of the hypopharynx. The left renal tumor was diagnosed as poorly differentiated squamous cell carcinoma metastasized from the hypopharynx. The patient remains alive, with no evidence of disease, 8 months following left nephrectomy. This case was thought to be the first report of a renal metastasis from a hypopharyngeal carcinoma that was diagnosed clinically and treated with nephrectomy.     

Cerebellar abscess: the impact of computed tomographic scanning

Thirty-four cases of cerebellar abscess, diagnosed by computed tomographic (CT) scanning, were managed according to a standard protocol during a 4-year period. Triple high dosage intravenous antibiotics were used, open catheter drainage of the abscess was instituted, and external ventricular drainage was added if obvious hydrocephalus was present. Seventeen patients made a good recovery, and five remained minimally disabled. Ten patients died, and two were left severely disabled. A relationship between the level of consciousness on admission and final outcome was established. In addition, two particular CT scan features (viz. the presence of hydrocephalus and the stage of the abscess) were significant adverse prognostic factors.