PMC3600230_01
Predrainage CT with contrast demonstrates calcified debris filling the pelvis and proximal ureter. There is destruction of the lower pole renal parenchyma (not pictured) which is contiguous with a 7 x 6 x 5 cm abscess and destruction of the upper pole renal parenchyma with a 4 x 3 x 2 cm abscess.
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fig1
Abdominal CT demonstrated a chronically hydronephrotic left kidney with calcified debris within the collecting system and perinephric abscesses extending anterior and posterolateral to the kidney (Figure 1). 
A retrograde pyelogram prior to surgery shows opacification of the dilated left renal collecting system with abundant internal debris noted within the renal pelvis and proximal ureter. The ureteropelvic junction appears narrowed, though obstruction elsewhere along the ureter and dilating reflux cannot be ruled out.
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fig2
Fluoroscopy demonstrated a narrowing at the ureteropelvic junction with migration of calcified debris into the proximal ureter (Figure 2).
Numerous foamy histiocytes forming granulomas with occasional plasma cells and lymphocytes (1000x image).
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fig3
Collections of foamy histiocytes admixed with lymphocytes and plasma cells were noted under the urothelium (Figure 3).