Abstract:An 18-month-old female child presented with fever and an abdominal mass, which, after ultrasonography, computed tomography, and magnetic resonance imaging was considered to be an atypical cystic renal neoplasm. Nephrectomy was performed. Histopathological examination demonstrated the mass to be focal xanthogranulomatous pyelonephritis. This lesion should be considered in the differential diagnosis of renal neoplasms in childhood, particularly cystic Wilms' tumor or Wilms' tumor with significant intratumoral he… Show more
“…MRI, and especially the T2 sequences, are useful with the absence of hyperintensity in the differentiation of XPN from tumoural masses. The different signal intensity of the solid component of XPN on T1-weighted images, compared to the renal parenchyma, depends on the amount of xanthoma cells occurring in the lesion [ 1 , 3 , 15 , 16 ]. Fig.…”
Xanthogranulomatous pyelonephritis (XPN) is an unusual and severe form of chronic inflammatory lesion of the kidney, characterised by the destruction of the renal parenchyma and the presence of multinucleated giant cells and lipid-laden macrophages, inflammatory infiltration and intensive renal fibrosis. There are a few cases in the literature which describe the disease in children. The pathomechanism of XPN is poorly understood. Renal obstruction with concomitant urinary tract infection is the most commonly associated pathological finding. The process is typically unilateral and may be focal or diffuse. In both cases, the perirenal infiltration is possible and can be mistaken for common renal neoplasm or inflammatory process. The symptoms are non-specific. Diagnostic imaging techniques with clinical suspicion have enabled XPN to be diagnosed and differentiated from malignancy with a high degree of confidence. Computed tomography (CT) is the mainstay of diagnostic imaging. The definitive diagnosis of XPN is based on pathological assessment after nephrectomy. We review and illustrate the clinical, radiological, surgical and pathological characteristics of XPN in children. All cases shown are surgically and histopathologically proven.Teaching Points
• XPN can present different clinical manifestations.
• CT is the mainstay of diagnostic imaging in XPN.
• Focal type of XPN should be included in the differential diagnosis of children with a renal mass.
• There are no clear guidelines on the management of XPN.
• Conservative and surgical treatments should be considered for each individual case.
• Histopathological examination confirms the diagnosis and excludes other benign and malign diseases.
“…MRI, and especially the T2 sequences, are useful with the absence of hyperintensity in the differentiation of XPN from tumoural masses. The different signal intensity of the solid component of XPN on T1-weighted images, compared to the renal parenchyma, depends on the amount of xanthoma cells occurring in the lesion [ 1 , 3 , 15 , 16 ]. Fig.…”
Xanthogranulomatous pyelonephritis (XPN) is an unusual and severe form of chronic inflammatory lesion of the kidney, characterised by the destruction of the renal parenchyma and the presence of multinucleated giant cells and lipid-laden macrophages, inflammatory infiltration and intensive renal fibrosis. There are a few cases in the literature which describe the disease in children. The pathomechanism of XPN is poorly understood. Renal obstruction with concomitant urinary tract infection is the most commonly associated pathological finding. The process is typically unilateral and may be focal or diffuse. In both cases, the perirenal infiltration is possible and can be mistaken for common renal neoplasm or inflammatory process. The symptoms are non-specific. Diagnostic imaging techniques with clinical suspicion have enabled XPN to be diagnosed and differentiated from malignancy with a high degree of confidence. Computed tomography (CT) is the mainstay of diagnostic imaging. The definitive diagnosis of XPN is based on pathological assessment after nephrectomy. We review and illustrate the clinical, radiological, surgical and pathological characteristics of XPN in children. All cases shown are surgically and histopathologically proven.Teaching Points
• XPN can present different clinical manifestations.
• CT is the mainstay of diagnostic imaging in XPN.
• Focal type of XPN should be included in the differential diagnosis of children with a renal mass.
• There are no clear guidelines on the management of XPN.
• Conservative and surgical treatments should be considered for each individual case.
• Histopathological examination confirms the diagnosis and excludes other benign and malign diseases.
“…Renal ultrasonography (US) may also help differentiate between focal and diffuse XGP, which is important since management may differ between types. US demonstrates renal enlargement with multiple hypoechoic areas in diffuse XGP and a localized hypoechoic mass in the focal subtype [ 28 , [46] , [47] , [48] , [49] , [50] , [51] ]. Magnetic resonance imaging (MRI) is an option in patients who are unable to tolerate CT contrast.…”
“…On imaging, XGP appears as an enlarged, nonfunctioning kidney, with a central calculus in a contracted renal pelvis and dilation of the calyces, which are filled with material corresponding to extensive inflammatory infiltrations, known as the "bear paw sign." 24,77 Due to the large central calculus, XGP is best depicted by CT (►Fig. 14).…”
Urinary tract infections (UTIs) commonly occur in children, and the clinical presentation varies depending on the child's age. The infection may affect only the bladder or may involve the kidneys and ureters. Multiple imaging modalities may be used to evaluate for underlying anomalies and complications of the infection. Here we discuss current imaging in pediatric UTI.
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