Archive | February, 2015

Flank Pain…

February 10, 2015


Flank pain for several days, history of nephrolithiasis:

Flank Pain 1 Flank Pain 2 Flank Pain 3 Flank Pain 4

This patient has marked right hydronephrosis with significant right renal perinephric inflammatory cystic changes extending into the contiguous right psoas musculature and right retroperitoneum. There is perinephric stranding and edema.

The differential in this case includes renal abscess (most likely) with extension into the right psoas and retroperitoneum.  Additional considerations are atypical infection such as tuberculosis, and urothelial malignancy.

The patient ended up having Xanthogranulomatous pyelonephritis.  This is a subacute/chronic pyelonephritis usually incited by a staghorn calculus.  For more information on this entity please see

Author:  Russell Jones, MD


1.  Knipe H, Gaillard F et al.  Xanthogranulomatous Pyelonephritis.  Accessed 1/2015.

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WWWTP #22 (What’s Wrong With This Picture?) Answer…

February 3, 2015


Patient presented short of breath.  Here is his chest xray:


What’s wrong with this picture?

The findings are very subtle.  This patient has multiple lucencies in the bony structures including ribs, clavicles, scapula, and visualized proximal humerus:

WWWTP 22 edited

This patient turned out to have leukemia.  His shortness of breath was actually symptomatic anemia and he had a severe leukocytosis with a WBC nearing 180 K/MM3.

Remember to approach all imaging with a systematic approach so you don’t miss subtle findings like this!

Author:  Russell Jones, MD

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