PMC3876624_01
Digital X-ray KUB showed a large soft tissue density in right lumbar region with loss of right psoas shadow, blurring of preperitoneal fat planes, displaced bowel loops and mild scoliosis of spine
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F1
Loss of right psoas shadow, blurring of pre-peritoneal fat planes and mild scoliosis of spine with concavity to right side was also noted [Figure 1].
Contrast enhanced CT scan Abdomen shows poorly excreting right kidney with loss of contour and corticomedullary differentiation. Heterogeneous collection replacing the kidney with extension into right pararenal space, under surface of liver, pelvis and involvement of right Psoas, quadratus lumborum and lateral abdominal wall muscles. Also noted is retroperitoneal lymphadenopathy
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F2
Inferior vena cava IVC was displaced anteriorly due to retroperitoneal lymphadenopathy; however, no evidence of extension of the lesion into IVC was seen [Figure 2].
Fine needle aspirate smear shows lipid laden macrophages and few haemosiderin laden macrophages consistent with the diagnosis of Xanthogranulomatous pyelonephritis (Haematoxylin and eosin; x40)
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F3
Drainage of extrarenal abscess under coverage of piperacillin-tazobactum and metronidazole was performed and aspirate sent for cytology which showed lipid laden macrophages with few haemosiderin laden macrophages consistent with the diagnosis of Xanthogranulomatous type of Pyelonephritis [Figure 3].