PMC5317070_01
Axial PET/ CT images of abdomen demonstratinghypodense abscess cavity in the postero inferior part ofright kidney with multiple pockets of air lucencies within (arrow) and FDG avid uptake in the peripheral enhancingpart(dotted arrow).
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F1
Interestingly, in the abdominal sections, a large heterogeneous peripherally enhancing hypodense 85x83x80 mm mass with peripheral FDG avidity and central void lesion containing multiple pockets of air lucencies within, was seen in the postero inferior aspect of right kidney [Figure 1a] within feromedial infiltration into the adjoining right psoas muscle [Figure 1b].
Coronal PET/CT sections showing extension and infiltration inferomedially into adjacent right psoas muscle (arrow)
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F2
The free gas lucency was also noted in non dependent part of the urinary bladder and hypodense debris amidst the contrast filled bladder at the right vescico ureteric junction [Figure 2].
Axial contrast CT section ofurinary bladder showing a hypodense filling defect at the right vesico ureteric junction(solid arrow) and freegas lucencies in the anterior aspectof urinary bladder(dotted arrow)
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F3
Ultrasonography (USG) revealed classical echogenic scattered echoes typical of free gas in a mixed echoic mass corresponding to the PET CT outlined lesion in the right kidney [Figure 3].
Ultrasound abdomen outlining enlarged right kidney with ill defined heterogeneous mass in postero inferior portion (arrow) containing dirty echogenic foci of air (dotted arrow).
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F4
The initial PET CT done prior to initiation of treatment was reviewed to see the renal morphology, which showed both kidneys of normal morphology and excretion [Figure 4].
Pre treatment staging coronal PET/CT images showing normal morphology of both kidneys.
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F5
The patient was followed up after three weeks with an ultrasonogarphy, which showed gratifying near complete disappearance of the abscess, and return of the renal contour to normal and disappearance of all the gas in the kidney and bladder as well [Figure 5].
Follow up ultrasonography showing complete disappearance of the abscess and return of the renal contour to normal.
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F6
Plain CT and topogram of abdomen subsequently revealed disappearance of free gas lucencies in the right renal region with DJ stent in situ [Figure 6a] with resolution of the emphysematous abscess, urinary bladder gas and debris [Figure 6b].