0022-534 7/78/1204-0490$02. 00/0 Vol. 120, October Printed in U.S.A.

THE JOURNAL OF UROLOGY

Copyright © 1978 by The Williams & Wilkins Co.

Case Reports RENAL PSEUDOTUMOR ON UROGRAPHY SECONDARY TO GALLBLADDER EMPYEMA THEODORE R. SMITH, STEPHEN R. BAKER AND MORDECAI KOENIGSBERG From the Department of Radiology, Albert Einstein College of Medicine, Bronx, New York

ABSTRACT

A case of gallbladder empyema is presented, which opacified initially on excretory urography and then on nephrotomography, mimicking a renal mass. Correct diagnosis was accomplished by angiography and ultrasound examination. With normal renal function gallbladder visualization on urography is indicative of a gallbladder abnormality. A case is presented of an unusual feature of an empyematous gallbladder mimicking a renal mass initially on excretory urography (IVP) and then on tomography. Identification and diagnosis of the mass were accomplished by angiography and sonography.

had the shape and location of an enlarged gallbladder with multiple stones also shown within it (fig. 4). It was not believed that the patient would tolerate a cholecystectomy and, therefore, cholecystostomy, stone removal and drainage of an empyematous gallbladder were done under general anesthesia.

CASE REPORT DISCUSSION

A 93-year-old white man was hospitalized for evaluation of a right lower quadrant abdominal mass. During the previous 4 weeks he had experienced occasional nausea and vomiting but no fever, weight loss or malaise. Before hospitalization a right lower quadrant fullness was noted. The patient had had a 7-year history of a duodenal ulcer that had been treated unsuccessfully with a medical regimen, including antacids, and radiotherapy. In 1972 he had undergone a vagotomy and, subsequently, an antecolic gastrojejunostomy, after which he did well. Physical examination revealed a temperature of 99.4F and a blood pressure of 130/90 mm. Hg. A firm, non-pulsatile, 14 by 20 cm., slightly tender mass was palpated in the right lower quadrant. There were basilar ronchi bilaterally, as well as diminished breath sounds at the right base. Laboratory studies demonstrated an erythrocyte sedimentation rate of 100 mm. per hour, white blood count 9,600/mm. 3 , hemoglobin 13.2 gm. per cent, hematocrit 38 per cent, urine culture greater than 100,000 Escherichia coli per high power field, total bilirubin 0.22 mg. per cent and alkaline phosphatase 239 mU./ ml. (normal 30 to 85 IU). An IVP revealed what appeared to be 2 large right renal masses (fig. 1). Subsequent nephrotomography showed the upper mass to be a typical benign cyst. A second thick-walled lucent lesion, closely associated with the anteroinferior margin of the right kidney, also was seen (fig. 2) and, because of its thick walls, a renal neoplasm could not be excluded. Arteriography, including selective right renal and superior mesenteric injections, was done (the celiac axis was stenotic and could not be catheterized). The superior mesenteric injection showed a wall of increased vascularity around the inferior mass, which was thought to represent a pathologically enlarged gallbladder, probably secondary to empyema (fig. 3). The upper pole right renal cyst also was confirmed. Oral cholecystography and intravenous cholangiography failed to opacify the gallbladder or biliary tree. Ultrasonography confirmed that the mass was separate from the right kidney and Accepted for publication February 10, 1978.

This patient, who presented with an abdominal mass, was examined initially with IVP, which revealed what appeared to be a lower pole right renal mass. Subsequent nephrotomography also showed a thick-walled lucent mass that could have arisen from the anteroinferior surface of the right kidney. However, superior mesenteric arteriography and sonography

Fm. 1. IVP shows large relatively lucent mass (arrows) over right lower renal pole, which appears to press on right ureter and right lower collecting system. Second mass effect is seen in right upper pole.

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shows lucent thick-walled mass (arrows). B, right posterior oblique close-up again shows outline.

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Renal pseudotumor on urography secondary to gallbladder empyema.

0022-534 7/78/1204-0490$02. 00/0 Vol. 120, October Printed in U.S.A. THE JOURNAL OF UROLOGY Copyright © 1978 by The Williams & Wilkins Co. Case Rep...
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