[Radiologic and gammagraphic findings in a case of pyonephrosis. Anatomopathologic correlation].
OBJECTIVE
To describe a case of pyonephrosis in a child with special reference to the importance of scintigraphy in its evaluation.


METHODS
We studied the correlation of the findings of conventional radiology (abdominal x-ray), ultrasound, abdominal CT, scintigraphy and anatomopathology (left kidney) in a 5-year-old boy with a history of renal lithiasis that was seen at our pediatric emergency services. The patient's clinical course and the scinscan findings using two tracers (Tc-99m DMSA, Ga-67 citrate) showed a severely compromised left renal function. The foregoing finding and the risk of major life-threatening complications prompted surgical treatment. Pathological analysis showed pyonephrosis of left kidney.


RESULTS
X-ray, ultrasound and abdominal CT showed left renal lithiasis, an enlarged left kidney, poor cortico-medullary differentiation and parenchymal destructuring with areas suggestive of cortical abscesses. A Ga-67 citrate scintiscan showed a notable intensity that completely affected the left renal parenchyma with no other changes. On the other hand, Tc-99m DMSA showed no uptake in the left kidney and normal uptake in the right kidney. A left nephrectomy was performed. Histological analysis demonstrated pyonephrosis of left kidney.


CONCLUSIONS
Tc-99m DMSA and Ga-67 citrate scintigraphy and the patient's poor clinical course showed the extent and severity of the underlying condition that was underestimated by the other imaging techniques.
Outomuro Perez
Juan Manuel
JM
Unidad de Medicina Nuclear Instituto Galego de Medicina Técnica (MEDTEC) Hospital Meixoeiro s.n. 36200 Vigo, Pontevedra España. joutomuro@hotmail.com
Lopez Lopez
Ana María
AM
Guitian Iglesias
Ramón
R
Bao Corral
Alfonso
A
Mata Varela
Juan
J
Vazquez Martule
Eduardo
E
D002675:Child, Preschool; D006801:Humans; D008297:Male; D011704:Pyelonephritis / Q000000981:diagnostic imaging* / Q000473:pathology; D011859:Radiography; D011877:Radionuclide Imaging