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Case of the Week 393 
What is the most likely diagnosis?
- 57 year-old diabetic with flank pain and fever
Unenhanced axial CT scan of abdomen
- Psoas abscess
- Lymphoma
- Xanthogranulomatous pyelonephritis
- Renal cortical necrosis
- Vertebral osteomyelitis
Additional Image - Enhanced axial CT scan of abdomen
Additional Images
Enhanced axial CT scan of abdomen
Answer:
.
3. Xanthogranulomatous pyelonephritis
.
.
More (Click Discussion Tab)
Xanthogranulomatous pyelonephritis
General considerations
- Rare, chronic inflammatory disease almost always associated with long-term obstruction
- Most often associated with Proteus or E. Coli infection
- Produces either diffuse (80-90%), or sometimes focal (10-20%), destruction of the kidney
- Almost always unilateral; may affect either kidney with equal frequency
- Four times more common in women than men, usually 45-65 years of age
- Pathognomonic microscopic feature is lipid-laden, foamy macrophage (xanthoma cells)
- Has tumor-like behavior and can spread to involve and/or destroy adjacent organs
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57 year-old diabetic with flank pain and fever |
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The top diagnostic imaging diagnoses that all medical students should recognize according to the Alliance of Medical Student Educators in Radiology |
Recognizing normal and key abnormal intestinal gas patterns, free air and abdominal calcifications |
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is an award-winning educational website aimed primarily at medical students and radiology residents-in-training, containing lectures, handouts, images, Cases of the Week, archives of cases, quizzes, flashcards of differential diagnoses and “most commons” lists, primarily in the areas of chest, GI, GU cardiac, bone and neuroradiology. |
