A case report: renal cystic tumoural calcinosis with ossification and bone marrow formation

BACKGROUND Emphysematous pyelonephritis (EPN) is a rare but fatal necrotic infection of the kidney, which usually leads to septic shock. Therefore, early diagnosis and optimized therapy are of paramount importance. In the past two decades, point-of-care ultrasound (POCUS) has been widely used in clinical practice, especially in emergency and critical care settings, and helps to rapidly identify the source of infection in sepsis. We report a rare case in which a “falls” sign on POCUS played a pivotal role in the early diagnosis of EPN. CASE SUMMARY A 57-year-old man presented with fever and lumbago for 3 d prior to admission. He went to the emergency room, and the initial POCUS detected gas bubbles in the hepatorenal space showing a hyperechoic focus with dirty shadowing and comet-tail artifacts. This imaging feature was like a mini waterfall. His blood and urine culture demonstrated Escherichia coli bacteremia, and EPN associated with septic shock was diagnosed. The patient did not respond to broad-spectrum antibiotic treatment and a perirenal abscess developed. He subsequently underwent computed tomography-guided percutaneous catheter drainage, and fully recovered. We also review the literature on the sonographic features of POCUS in EPN. CONCLUSION This case indicates that a “falls” sign on POCUS facilitates the rapid diagnosis of severe EPN at the bedside.

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A rare case of a cystic renal mass with heterotopic ossification and a mini literature review

Wang

Zhang

Zhu

et al. 2021

XST

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INTRODUCTION: It is a challenge to make accurate pre-surgical diagnosis for renal tumors. This study is to report the findings, management, and outcome of one rare case of ossification in a cystic renal mass. We present and discuss the pathological characteristics, radiologic features, and treatment alternatives of the patient. PATIENTS AND METHODS: A 38 years old female patient had intermittent epigastric pain and microscopic hematuria for two months. Computerized tomography (CT) scan and Magnetic Resonance imaging (MRI) showed a mass with rough edge and dense calcification in the upper pole of the right kidney and normal left kidney. Pre-operative diagnosis is cystic nephroma or cystic renal mass (Bosniak III type, Bosniak renal cyst classification). GFR was within normal limits for age and no other significant laboratory aberrations were noted. Patient underwent a right retroperitoneal laparoscopic partial nephrectomy (margin status was negative). A mini literature review was performed to highlight the principals of diagnosis and treatment of cystic renal mass with heterotopic ossification. RESULTS: The entire renal mass was successfully removed from upper pole of the right kidney by laparoscopic nephron sparing surgery. The size of renal mass is 38×35×30 mm3 with thick and hard capsular wall. The cystic cavity contains yellow lipid-like substances without stone. Histological examination revealed renal cyst in which the cyst wall reveals fibrosis and no obvious lining epithelium. The additional unique feature includes the presence of dense calcification and ossification in the renal mass. Localization tissue of yellow bone marrow was detected. No complications occurred in 9 months after surgery during follow-up. CONCLUSIONS: Cystic renal mass with heterotopic ossification is a rare case of non-malignant renal tumor. Whether surgery is needed depends to whether patients have symptoms. For symptom renal tumors, laparoscopic nephron sparing surgical procedure is recommended. Furthermore, complete surgical resection of the lesion is needed when the mass is suspected to be malignant. An accurate histologic diagnosis is key in its diagnosis.

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A case report: renal cystic tumoural calcinosis with ossification and bone marrow formation

Cited by 3 publications

References 11 publications

A very rare case of bone metaplasia of renal cyst: A case report

A very rare case of bone metaplasia of renal cyst: A case report

Point-of-care ultrasound for the early diagnosis of emphysematous pyelonephritis: A case report and literature review

A rare case of a cystic renal mass with heterotopic ossification and a mini literature review

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