Imaging Manifestations of Acute and Chronic Renal Infection That Mimics Malignancy: How to Make the Diagnosis Using Computed Tomography and Magnetic Resonance Imaging

Canadian Association of Radiologists Journal - Tập 70 - Trang 424-433 - 2019
Amar Udare1, Jorge Abreu-Gomez1, Satheesh Krishna2, Matthew McInnes1, Evan Siegelman3, Nicola Schieda1
1Department of Medical Imaging, the Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
2Joint Department of Medical Imaging, Toronto General Hospital, The University of Toronto, Toronto, Ontario, Canada
3Department of Radiology, The Hospital of the University of Pennsylvania Philadelphia; Pennsylvania, USA

Tóm tắt

Purpose To review the computed tomography and magnetic resonance imaging manifestations of acute and chronic renal infections that may mimic malignancy and to provide useful tips to establish an imaging diagnosis. Conclusion Acute and chronic bacterial pyelonephritis are usually readily diagnosed clinically and on imaging when the diagnosis is suspected based upon clinical presentation. When unsuspected, focal, extensive or mass-like, acute and chronic bacterial pyelonephritis may mimic infiltrative tumours such as urothelial cell carcinoma (UCC), lymphoma, and metastatic disease. Infection may be suspected when patients are young and otherwise healthy when there is marked associated perinephric changes and in the absence of metastatic adenopathy or disease elsewhere in the abdomen and pelvis. Renal abscesses, from bacterial or atypical microbial agents, can appear as complex cystic renal masses mimicking cystic renal cell carcinoma. Associated inflammatory changes in and around the kidney and local invasion favour infection. Emphysematous pyelonephritis can mimic necrotic or fistulizing tumour; however, infection is more likely and should always be considered first. Xanthogranulomatous pyelonephritis can mimic malignancy when focal or multifocal and in cases without associated renal calculi. Malacoplakia is an inflammatory process that may mimic malignancy and should be considered in patients with chronic infection. Bacillus Calmette-Guerin (BCG)-induced pyelonephritis is rare but can mimic renal malignancy and should be considered in patients presenting with a renal mass when being treated with BCG for urinary bladder UCC.

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Canadian Association of Radiologists Journal

Tập 70

424-433

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