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McArthur M, Patel M. A pictorial review of genitourinary infections and inflammations. Clin Imaging 2023; 104:110013. [PMID: 37918136 DOI: 10.1016/j.clinimag.2023.110013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/03/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
Various infectious and inflammatory diseases affect the genitourinary system. This paper provides a review of multiple common and uncommon infectious and inflammatory conditions affecting the genitourinary system and some associated complications. These include acute infectious cystitis, emphysematous cystitis, acute pyelonephritis, emphysematous pyelonephritis, renal and perinephric abscesses, pyonephrosis, xanthogranulomatous pyelonephritis, epididymo-orchitis, vasitis, prostatitis, pelvic inflammatory disease, renal hydatid infection, renal tuberculosis, actinomycosis, Erdheim-Chester Disease, IgG4-Related Kidney Disease, urethritis and urethral strictures, ureteritis cystica, and genitourinary fistulas. Radiologists should be aware of these diseases' complications and management. Uncommon conditions must be considered when evaluating the genitourinary system.
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Affiliation(s)
- Mark McArthur
- University of California, Los Angeles, United States.
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Yano T, Takada T, Fujiishi R, Fujii K, Honjo H, Miyajima M, Takeshima T, Hayashi M, Miyashita J, Azuma T, Fukuhara S. Usefulness of computed tomography in the diagnosis of acute pyelonephritis in older patients suspected of infection with unknown focus. Acta Radiol 2022; 63:268-277. [PMID: 33508952 DOI: 10.1177/0284185120988817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In older adults, the diagnosis of acute pyelonephritis is challenging because of non-specific symptoms and false-positive urine test results. Few studies have investigated the diagnostic performance of computed tomography (CT) signs. PURPOSE To evaluate the diagnostic performance of CT signs for acute pyelonephritis in older patients suspected of infection with unknown focus. MATERIAL AND METHODS This cross-sectional study was conducted between 2015 and 2018. Patients aged ≥65 years who underwent blood cultures, urine culture, and non-contrast or contrast-enhanced CT on admission were included. Cases with clinically presumable infection focus before CT were excluded. Two radiologists blinded to clinical information independently reviewed five CT signs: perirenal fat stranding; pelvicalyceal wall thickening and enhancement; renal enlargement; thickening of Gerota's fascia; and area(s) of decreased attenuation. The final diagnoses were made by a clinical expert panel. RESULTS Among 473 eligible patients, 61 were diagnosed with acute pyelonephritis. When the laterality of findings between the left and right kidneys were considered, the positive and negative likelihood ratios of perirenal fat stranding were 4.0 (95% confidence interval [CI] = 2.3-7.0) and 0.8 (95% CI = 0.7-0.9) in non-contrast CT, respectively. The other signs in non-contrast CT showed similar diagnostic performance with positive and negative likelihood ratios of 3.5-11.3 and 0.8-0.9, respectively. CONCLUSION CT signs can help physicians diagnose acute pyelonephritis in older patients suspected of infection with unknown focus.
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Affiliation(s)
- Tetsuhiro Yano
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
- Graduate School of Medicine, Fukushima Medical University. Fukushima City, Fukushima, Japan
| | - Toshihiko Takada
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryuto Fujiishi
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
| | - Kotaro Fujii
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
| | - Hiroshi Honjo
- Department of Radiology, Shirakawa Kosei General Hospital, Shirakawa City, Fukushima, Japan
| | - Masayuki Miyajima
- Department of Radiology, Shirakawa Kosei General Hospital, Shirakawa City, Fukushima, Japan
| | - Taro Takeshima
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
| | - Michio Hayashi
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
| | - Jun Miyashita
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Teruhisa Azuma
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
| | - Shunichi Fukuhara
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Demirelli E, Öğreden E, Bayraktar C, Tosun A, Oğuz U. The effect of perirenal fat stranding on infectious complications after ureterorenoscopy in patients with ureteral calculi. Asian J Urol 2021; 9:307-312. [PMID: 36035336 PMCID: PMC9399543 DOI: 10.1016/j.ajur.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/27/2021] [Accepted: 07/13/2021] [Indexed: 12/05/2022] Open
Abstract
Objective Perirenal fat stranding (PFS) is linear areas of soft-tissue attenuation in the perirenal space on non-contrast computed tomography. The present study aimed to investigate whether PFS is associated with infectious complications after ureterorenoscopy (URS) in patients with ureteral calculi in any location. Methods The data of 602 patients with ureteral stones who underwent URS were analyzed retrospectively. The patients were divided into two groups as Group 1 (PFS not detected) and Group 2 (PFS detected). Gender, and age of patients, size, side, and location of the stone, operation time, double-J stent insertion status, perioperative ureter injury, postoperative infection after URS and related complications, and duration of hospital stay were compared. Results While PFS was not detected in 530 patients, PFS was detected in 72 patients. The mean age, male/female ratio, side and localization of the stones, operation time, and perioperative insertion of the double-J after lithotripsy were statistically similar (p>0.05). The median stone diameter was smaller in Group 2 (9 mm vs. 8 mm) (p=0.033). Fever was observed in 30 and 38 patients in Group 1 and Group 2, respectively (p=0.0001). Urinary tract infection was detected in 24 and 27 patients in Group 1 and Group 2, respectively (p=0.0001). The urosepsis did not occur in any patients in Group 1, whereas 8 (11.1%) patients in Group 2 experienced urosepsis (p=0.0001). Conclusion According to the results of the present study, patients with ureteral stones accompanied by PFS are much more prone to ureteral injuries and infectious complications such as urinary tract infection, fever, and sepsis after URS.
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Affiliation(s)
- Erhan Demirelli
- Giresun University, Faculty of Medicine, Department of Urology, Giresun, Turkey
- Corresponding author.
| | - Ercan Öğreden
- Giresun University, Faculty of Medicine, Department of Urology, Giresun, Turkey
| | - Cemil Bayraktar
- Ministry of Health, Kayseri City Hospital, Department of Urology, Kayseri, Turkey
| | - Alptekin Tosun
- Giresun University, Faculty of Medicine, Department of Radiology, Giresun, Turkey
| | - Ural Oğuz
- Giresun University, Faculty of Medicine, Department of Urology, Giresun, Turkey
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Miyagami T, Takada A, Shimizu T, Naito T. Delayed diagnosis of a piriformis abscess due to hyposkillia and communication error. BMJ Case Rep 2021; 14:e242088. [PMID: 34380675 PMCID: PMC8359517 DOI: 10.1136/bcr-2021-242088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 11/04/2022] Open
Abstract
A 69-year-old man with dementia presented to our hospital with fever and left back pain. He was diagnosed with acute pyelonephritis based on microscopy and CT findings indicating bacteriuria and elevated fat density around the right kidney, respectively. Three days post admission, the diagnosis of a urinary tract infection was queried and the patient was re-examined. Marked tenderness was observed in the left buttock; contrast CT scan was subsequently performed and a left piriformis abscess was diagnosed. This diagnostic delay occurred due to a communication error-the referral letter to the radiologist stated 'fever and back pain'-and the physician's hyposkillia; hence, differential diagnoses were not considered. Physicians can reduce the frequency of related errors by conducting proper physical examinations and not relying on imaging findings alone. Furthermore, to ensure accurate diagnoses, the comments to the radiologist should be clear and detailed when requesting diagnostic imaging.
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Affiliation(s)
| | - Arisa Takada
- General medicine, Juntendo Daigaku, Bunkyo-ku, Japan
| | - Taro Shimizu
- Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga-gun, Japan
| | - Toshio Naito
- General medicine, Juntendo Daigaku, Bunkyo-ku, Japan
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Shima H, Kimura T, Nishiuchi T, Iwase T, Hashizume S, Takamori N, Harada M, Higashiguchi Y, Masaki C, Banno T, Nagasaka N, Ito A, Inoue T, Tashiro M, Nishitani M, Kawahara K, Okada K, Minakuchi J. Successful treatment of direct hemoperfusion with polymyxin B-immobilized fiber for septic shock and severe acute kidney injury due to ceftriaxone-resistant Escherichia coli: a case report with literature review. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00266-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Septic shock is a life-threatening condition and one of the most common causes of acute kidney injury. Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) is used to reduce endotoxin levels in blood. Here, we report a rare but important case of sepsis-induced acute kidney injury and septic shock, which was successfully treated with PMX-DHP in spite of inappropriate initial antibiotic therapy.
Case presentation
An 84-year-old man was hospitalized for septic shock and acute kidney injury. Although he was treated with ceftriaxone, he did not recover from hypotension and had reduced urine output. After initiating PMX-DHP on days 3 and 4, his blood pressure was immediately elevated and his white blood cell count and C-reactive protein levels improved. Because ceftriaxone-resistant Escherichia coli was identified in blood culture, we changed his antibiotics to levofloxacin on day 7. He successfully recovered from the septic shock and dialysis was withdrawn.
Conclusions
Considering the use of inappropriate initial antibiotics, the early induction of PMX-DHP might have been a key determinant of his outcome. PMX-DHP therapy should be considered in septic shock in addition to antibiotic treatment.
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Primary and secondary diseases of the perinephric space: an approach to imaging diagnosis with emphasis on MRI. Clin Radiol 2020; 76:75.e13-75.e26. [PMID: 32709392 DOI: 10.1016/j.crad.2020.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/17/2020] [Indexed: 12/21/2022]
Abstract
The perinephric space is the middle compartment of the retroperitoneum, containing the kidneys and adrenal glands. Differential considerations for diseases involving primarily the perinephric space differ from those arising from the kidney itself, show variant imaging features, and require identification and characterisation by interpreting radiologists-an imaging diagnosis can be suggested in many cases. Lymphangiomas are congenital cystic lesions that may contain lipid-laden chyle, which may be detectable on magnetic resonance imaging (MRI). Retroperitoneal fibrosis, Erdheim-Chester disease, and lymphoma may present as a perinephric soft tissue rind. Osseous findings favour Erdheim-Chester, ureteric obstruction favours retroperitoneal fibrosis, and associated lymphadenopathy with mass-effect, but without invasion of adjacent structures favours lymphoma. Extramedullary haematopoiesis and brown fat stimulation are both characterised by signal drop on opposed-phase T1-weighted (W) images, the former resulting from severe anaemia and the latter in the context of elevated serum catecholamines, especially in the setting of phaeochromocytoma. Liposarcoma is the most common primary sarcoma of the retroperitoneum. Metastases are uncommon; however, they can be seen in melanoma, among other primary malignancies. Increased T1W signal hyperintensity is typical of melanoma metastases and haematomas. Abscesses show non-enhancing fluid centrally with marked diffusion restriction. This article presents a review of the perinephric space, pathological conditions of the perinephric space, and an approach towards imaging and diagnosis using cross-sectional imaging, with emphasis on MRI. MRI provides better tissue characterisation, assessment of enhancement kinetics, and detection of intralesional fat in comparison to CT. Clinical and laboratory correlation or tissue sampling may be required for definitive diagnosis in some cases.
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Kvasnička J, Lambert L, Waldauf P, Zelinka T, Petrák O, Štrauch B, Holaj R, Indra T, Krátká Z, Klímová J, Václavík J, Kociánová E, Nykl I, Jiravský O, Rappová G, Táborský M, Branny M, Widimský J, Rosa J. (Prediction of long-term renal denervation efficacy). COR ET VASA 2019. [DOI: 10.1016/j.crvasa.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tanizaki R, Ichikawa S, Takemura Y. Clinical impact of perinephric fat stranding detected on computed tomography in patients with acute pyelonephritis: a retrospective observational study. Eur J Clin Microbiol Infect Dis 2019; 38:2185-2192. [PMID: 31372906 DOI: 10.1007/s10096-019-03662-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/24/2019] [Indexed: 11/26/2022]
Abstract
Perinephric fat stranding (PFS) is often detected on computed tomography (CT) in patients with acute pyelonephritis (APN). However, its clinical impact remains unclear. This study aimed to evaluate the clinical impact of PFS detected on CT in patients with APN. This retrospective observational study included patients with APN who underwent CT (median age, 79.5 years). Patients were classified into PFS (patients with PFS observed on CT) and non-PFS (patients without PFS observed on CT) groups, which were further classified into bacteraemia and non-bacteraemia groups. Clinical findings between the groups were compared. Among 194 patients who underwent CT, 111 (57.2%) patients demonstrated PFS. The rate of bacteraemia was significantly higher in the PFS group than in the non-PFS group (55.2 vs. 23.1%, p < 0.001). CT findings other than PFS were not associated with bacteraemia. The median peak body temperature was significantly higher in the PFS group than in the non-PFS group (38.8 vs. 38.5 °C, p < 0.001); however, the duration of fever and in-hospital mortality rates were not significantly different between the groups. Concordance between blood and urine culture results was observed in 75.0% of the patients; the presence of PFS was not different between patients with concordant and discordant results, regardless of the pre-treatment antibiotic used. Our findings suggest that the presence of PFS in patients with APN predicts bacteraemia; thus, clinicians should consider obtaining blood cultures if PFS is found on CT in patients with APN, even if the patients had received antibiotics prior to admission.
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Affiliation(s)
- Ryutaro Tanizaki
- Department of Community Medicine, Nabari, Mie University School of Medicine, Tsu, Mie, Japan.
- General Internal Medicine and Family Medicine, Nabari City Hospital, Nabari, Mie, Japan.
- Department of Internal Medicine, Ise Municipal General Hospital, Ise, Mie, Japan.
| | - Shuhei Ichikawa
- Department of Community Medicine, Nabari, Mie University School of Medicine, Tsu, Mie, Japan
| | - Yousuke Takemura
- Department of Family Medicine, Mie University School of Medicine and Graduate School of Medicine, Tsu, Mie, Japan
- Department of Family Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Venketesan S, Jain D, Viswanathan S, Gayathri MS. Case Report: Acute pyelonephritis and hearing loss in scrub typhus. F1000Res 2019; 8:312. [PMID: 31327998 PMCID: PMC6613477 DOI: 10.12688/f1000research.18129.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2019] [Indexed: 12/05/2022] Open
Abstract
Acute pyelonephritis is a common renal manifestation in patients with diabetes. A 52-year-old diabetic lady presented with loin pain, dysuria, and fever and urinary incontinence that had begun seven and three days prior to presentation respectively. She was treated with escalating spectra of intravenous antibiotics without improvement. Urine and blood cultures were sterile, while radiological investigations were suggestive of pyelonephritis. Mild hepatic dysfunction prompted consideration of scrub typhus and she improved with empirical doxycycline. Scrub IgM was later confirmed to be positive. In conclusion, local prevalence of systemic infections such as rickettsioses should always be considered in diabetics with fever, even if symptoms and signs otherwise suggest typical diabetes-related infections. We, therefore report a case of acute pyelonephritis caused by scrub typhus which has not been previously described in English medical literature.
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Affiliation(s)
- Sivaranjini Venketesan
- Department of General Medicine, Indira Gandhi Medical College & Research Institute, Pondicherry, Puducherry, 605009, India
| | - Dheeraj Jain
- Department of General Medicine, Indira Gandhi Medical College & Research Institute, Pondicherry, Puducherry, 605009, India
| | - Stalin Viswanathan
- Department of General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)., Pondicherry, Puducherry, 605009, India
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Farrell MR, Papagiannopoulos D, Ebersole J, White G, Deane LA. Perinephric Fat Stranding Is Associated with Elevated Creatinine Among Patients with Acutely Obstructing Ureterolithiasis. J Endourol 2018; 32:891-895. [PMID: 29943669 DOI: 10.1089/end.2018.0252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Pyelovenous/pyelolymphatic backflow from acute ureteral obstruction, manifesting radiologically as perinephric fat stranding (PFS), may result in elevated serum creatinine. Among patients with acutely obstructing ureterolithiasis, we evaluated the relationship between degree of PFS and changes in serum creatinine from baseline. METHODS Our tertiary care center's radiology dictation system (Fluency Discovery, M Modal) was queried for noncontrast abdominopelvic CT studies obtained in the Emergency Department for patients with obstructing ureteral calculi from 7/2015 to 4/2016. A single radiologist blinded to clinical data reviewed all CT scans and coded stone size, location, severity of hydronephrosis, and degree of PFS (none, mild, moderate, severe). For patients who met imaging criteria, a retrospective chart review was performed. RESULTS We evaluated 148 patients with mean age of 46 years (SD 14.6), 56.0% (n = 83) were male. On univariate analysis, moderate-severe perinephric stranding was associated with elevated creatinine from baseline (OR 2.93, p = 0.03). Mean creatinine increased as the severity of stranding increased (none Cr = 0.978 mg/dL, mild Cr = 0.983 mg/dL, moderate Cr = 1.165 mg/dL, severe Cr = 1.370 mg/dL; p < 0.01). An increase in creatinine from baseline was not associated with greater severity of hydronephrosis (OR 0.504, p = 0.189). There was no association between degree of PFS and severity of hydronephrosis, positive urine culture, stone location, or symptom duration (p > 0.05). On regression analysis controlling for positive urine culture and degree of hydronephrosis, there remained an association between elevated serum creatinine from baseline and moderate-severe PFS (OR 9.0, p = 0.01). CONCLUSIONS Among patients with acute obstructive ureterolithiasis, moderate-severe PFS was associated with elevated serum creatinine from baseline. This elevated creatinine was not explained by the obstructed kidney alone, as there was no association between the severity of hydronephrosis and increased creatinine. Pyelovenous/pyelolymphatic backflow resulting in PFS may be a contributing factor to elevated serum creatinine in this setting.
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Affiliation(s)
- M Ryan Farrell
- 1 Division of Urology, Rush University Medical Center , Chicago, Illinois
| | | | - John Ebersole
- 2 Department of Radiology, Rush University Medical Center , Chicago, Illinois
| | - Gregory White
- 2 Department of Radiology, Rush University Medical Center , Chicago, Illinois
| | - Leslie A Deane
- 1 Division of Urology, Rush University Medical Center , Chicago, Illinois
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