THE ROLE OF RADIOLOGY IMAGING FOR DIAGNOSING

XANTHOGRANULOMATOUS PYELONEPHRITIS

C.S Kusumaningrum1, I.Indriyani2

1
Resident of Radiology, 2 Staff of Radiology Department in
Dr. Moewardi General Hospital, Faculty of Medicine Sebelas Maret University, Surakarta

ABSTRACT

BACKGROUND
Xanthogranulomatous pyelonephritis is a rare renal tumor that arises as a complication of an
uncommon chronic destructive granulomatous process of the renal parenchyma. This
condition is associated with long-term urinary tract obstruction (Staghorn calculi) and
infection. It affects females more often than males, is more common in the middle-aged, and
most cases are unilateral. Computed tomography may demonstrate diffuse or focal form.

CASE REPORT
A 46-year-old woman was admitted to the hospital, because of a lump in the left abdomen
that has been getting bigger for the past 5 months, feels pain, the patient has difficulty
doing activities, and the stomach feels full. A CT scan of the abdomen with intravenous
contrast revealed an enlarged left kidney with multiple low-density lobulated appearances,
thickened walls and septations suggestive of necrosis or abscess, and a little staghorn
calculus at the renal pelvis, with bear's paw sign. The diagnosis of xanthogranulomatous
pyelonephritis was suggested. Eventually, she underwent pre-operative embolization and
left-sided total nephrectomy.

DISCUSSION
Xanthogranulomatous pyelonephritis is a granulomatous inflammation of the renal
parenchyma due to chronic urinary tract infection often associated with renal stones. On the
abdominal CT scan, it is detected as an enlargement of the kidney, with multiple hypoechoic
areas, calyceal dilation, necrosis, and abscess and, with the characteristic of bear paw sign.
Fine-needle aspiration biopsy is recommended to confirm the diagnosis. Since it is an
irreversible condition, a total nephrectomy is recommended.

CONCLUSION
Xanthogranulomatous pyelonephritis is an uncommon chronic destructive granulomatous
process of renal parenchyma in association with long-term urinary tract obstruction and
infection. CT findings are most helpful in reaching the correct diagnosis. Both antibiotics and
surgery can be treatment options depending on the patient's disease status.

Keywords: Xanthogranulomatous Pyelonephritis, Abdominal CT, Bear's paw sign