Hepatic abscess rupture into the pyelocalyceal system of right kidney.

A 42-year old male patient presented with the complaints of right lumbar pain, high-grade fever, burning micturition and pyuria for past 4 days. He was diagnosed with a liver abscess which had ruptured into the superior pole of right kidney.

INTRODUCTION

Ruptue of amebic liver abscess into the retroperitoneum is uncommon.[1] We present images of a patient with a pyogenic liver abscess that ruptured into the pyelocalyceal system of the right kidney and was draining through the urinary tract.

CASE REPORT

A 42-year-old chronic alcoholic male presented with dull-aching right lumbar pain, high-grade fever, burning micturition and passage of frank pus in the urine for 4 days. The renal function tests were deranged with serum creatinine 4.5 mg/dl and urea 80 mg/dl. The patient was catheterized and frank pus was seen draining into the urobag. The patient was resuscitated with fluids and intravenous antibiotics. After 3 days of treatment, the renal function tests improved and a contrast-enhanced computed tomography (CECT) was performed. The CECT findings revealed a large hepatic abscess in the right hepatic lobe with internal air foci having a clear communication with the pyelocalyceal system at the superior pole of right kidney. There was no sign of obstructive uropathy. A small (non-obstructing) 7-mm calculus was seen in the inferior pole calyx of right kidney [Figures 1 and 2]. The patient was managed by ultrasound-guided percutaneous drainage of the liver abscess and intravenous antibiotics. The condition improved over a period of 7 days and the patient was discharged.

Figure 1

Coronal and axial contrast-enhanced computed tomography images showing a large hepatic abscess with internal air foci (downward arrow) having direct communication with the pyelocalyceal system through the superior pole calyces (oblique arrow) and a small hyperdense nonobstructing calculus in the inferior pole calyx. No evident significant hydronephrosis is seen

Figure 2

Sagittal contrast-enhanced computed tomography reformation displaying the communication between the liver abscess and superior pole of the right kidney (arrow)

DISCUSSION

Rupture of a liver abscess into the pyelocalyceal system is uncommon as is pyonephrosis breaching the renal capsule to cause ascending infection of the liver, due to tough nature of Gerota's fascia and Glisson's capsule.[2] Radiological appearance of such situations are unique.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.