Abstract
Four cases of diffuse xanthogranulomatous pyelonephritis (XPN) in young children are presented. In three patients the clinical picture was one of weight loss, anaemia and neutrophilia with a large renal mass. The fourth presented with haematuria. Ultrasound (US) and CT findings were almost identical in all four patients. US showed the affected kidney was massively enlarged but retained a reniform shape. Dilated fluid spaces containing calculi were present. CT confirmed the US findings and revealed peripheral enhancement without contrast excretion, with dilated calyceal spaces producing the “bear paw sign”. Extrarenal extension into abdominal wall and psoas muscle is typical and was well demonstrated by CT. The affected kidneys were non-functioning and nephrectomy was required. Typical US and CT features allow a confident diagnosis of XPN and appropriate early treatment.
Similar content being viewed by others
References
Parker MD, Clark RL (1989) Evolving concepts in the diagnosis of xanthogranulomatous pyelonephritis. Urol Radiol 11: 7–15
Tolia BM, Iloreta A, Freed SZ, Fruchtman B, Bennett B, Newman HR (1981) Xanthogranulomatous pyelonephritis: detailed analysis of 29 cases and a brief discussion of atypical presentations. J Urol 126: 437–442
Braun G, Moussali L, Balanzar JL (1985) Xanthogranulomatous pyelonephritis in children. J Urol 133: 236–239
Graiver L, Vargas MA (1972) Xanthogranulomatous pyelonephritis in childhood. Am J Dis Child 123: 156–158
Goldman SM, Hartman DS, Fishman EK, Finizio JP, Gatewood OMB, Siegelman SS (1984) CT of xanthogranulomatous pyelonephritis: radiologic-pathologic correlation. AJR 141: 963–969
Hughes PM, Gupta SC, Thomas NB (1990) Case report: xanthogranulomatous pyelonephritis in childhood. Clin Radiol 41: 360–362
Zafaranloo S, Gerard PS, Bryk D (1990) Xanthogranulomatous pyelonephritis in children: analysis by diagnostic modalities. Urol Radiol 12: 18–21
Bagley FH, Stewart AM, Jones PF (1977) Diffuse xanthogranulomatous pyelonephritis in children: an unrecognised varian. J Urol 18: 434–435
Garel L, Brunelle F, Montagne J (1979) Les pyelonephrites xanthogranulomateuses de l'enfant. Ann Radiol 22: 207–212
Malek RS, Elder JS (1978) Xanthogranulomatous pyelonephritis: a critical analysis of 26 cases and of the literature. J Urol 119: 589–593
Hartman DS, Davis CJ, Goldman SM, Isbister SS, Saunders RC (1984) Xanthogranulomatous pyelonephritis: sonographic-pathologic correlation of 16 cases. J Ultrasound Med 3: 481–488
Van Kirk OC, Go RT, Wedel VJ (1980) Sonographic features of xanthogranulomatous pyelonephritis. AJR 134: 1035–1039
Subramanyam BR, Megibow AJ, Raghavendra NB, Bosniak MA (1982) Diffuse xanthogranulomatous pyelonephritis: analysis by computed tomography and sonography. Urol Radiol 4: 5–9
Abbate AD, Meyers J (1976) Xanthogranulomatous pyelonephritis in childhood. J Urol 116: 231–233
Kenney PJ (1990) Imaging of chronic renal infections. AJR 155: 485–494
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Cousins, C., Somers, J., Broderick, N. et al. Xanthogranulomatous pyelonephritis in childhood: Ultrasound and CT diagnosis. Pediatr Radiol 24, 210–212 (1994). https://doi.org/10.1007/BF02012194
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02012194