PMC4996593_01
Complicated cyst diameter 41 mm, Bosniak IIF, calcifications in the wall by ultrasonography (A), diagnosed 10 years ago by noncontrast CT (B), no signs of progression.
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The cyst had been followed up by ultrasonography with no signs of progression (Fig. 1).
Renal abscess located dorsally and caudally from the cyst, diameter 29 mm, hypoechoic content with floating particles (A), increased perfusion around (B), by ultrasonography.
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Ultrasonography revealed a new cystic lesion in the left kidney measuring 29 mm in diameter with hypoechoic content of floating particles and increased perfusion around (Fig. 2).
Suspect protrusion of the abscess to the cyst by MRI.
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Stratification of liquid contents with different intensity suggested to represent pus inside the lesion (Fig. 3).
Percutaneous insertion of two drains into the abscess (A), filiform leakage of contrast to the urinary system (B), insertion of a new Single-J stent; persistent communication between urinary system and abscess (C), no more signs of communication between urinary tract and abscess (D).
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We therefore inserted two percutaneous drains into the lesion (Fig. 4A) for optimal drainage and 70 mL of pus was evacuated. A Double-J stent (6F) was inserted immediately and was followed by a prompt reduction in the external drainage fluid to 10 mL per day (Fig. 4B). We have now replaced the Double-J stent with a long Single-J stent to provide better monitoring of the total urine production of the left kidney (Fig. 4C). We further performed retrograde pyelography on the 15th day, which showed no signs of communication between the urinary system and the lesion (Fig. 4D) and the external drain was removed.