Perirenal abscess
Introduction
Introduction to perirenal abscess Perirenal abscess is mainly caused by the intrarenal abscess breaking into the kidney. Therefore, the pathogenic bacteria are the same as the intrarenal abscess. In about 25% of cases, the abscess can produce a variety of pathogenic bacteria. Perirenal fascia usually confines the abscess around the kidney, and the pathogenesis is the same as the intrarenal abscess. The difference between clinically and acute pyelonephritis is that the former has long-term symptoms before hospitalization, and long-term fever after antibiotic treatment begins; the symptoms of perirenal abscess generally last more than 5 days, and acute Pyelonephritis is generally shorter than 5 days. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: atelectasis pleural effusion
Cause
Causes of perirenal abscess
Cause (45%):
It is mainly caused by the intrarenal abscess breaking into the kidney. It can be caused by a variety of pathogenic bacteria. In recent years, due to the widespread use of broad-spectrum antibiotics, blood-borne infections have been decreasing. The pathogenic bacteria have been mainly Staphylococcus aureus, and have been transformed into Escherichia coli and Proteus, golden yellow grapes. The second is the cocci. Other pathogens include many Gram-negative bacilli such as Klebsiella, Enterobacter, Pseudomonas, and Pseudomonas aeruginosa. Certain anaerobic bacteria such as Clostridium, Bacillus and actinomycetes can also cause disease.
Prevention
Perirenal abscess prevention
Timely diagnosis and effective treatment, the patient's prognosis is good, and mortality is related to delayed diagnosis and inappropriate treatment.
Complication
Perirenal abscess complications Complications, atelectasis, pleural effusion
Without specific complications, the patient may have pain when bending over, a painful mass in the lower back, and redness of the skin is a late sign of perirenal abscess.
Symptom
Perirenal abscess symptoms Common symptoms Pyogenic leukocytosis, psoas muscle shadow disappeared, atelectasis pleural effusion
Common leukocytosis and pyuria, but not all patients, most patients with positive urine culture, blood culture positive accounted for 20% to 40%, the difference between clinical and acute pyelonephritis in the periorbital abscess is that the former is hospitalized There have been symptoms for a long time before, and long-term fever after the start of antibiotic treatment; the symptoms of perirenal abscess generally last more than 5 days, and acute pyelonephritis is generally shorter than 5 days.
Ultrasound usually shows abscesses, but CT is the most reliable method of examination. Almost all perirenal abscesses can be detected by CT. About half of patients with X-ray chest examination have abnormalities, ipsilateral pneumonia, atelectasis, and pleural cavity. The liquid or the lateral side of the affected side is elevated. About half of the patients have abnormal abdominal plain films. The tumors, stones, shadows of the psoas muscles disappeared, and the intestinal gas in the perirenal area caused by the gas-producing bacteria infection. The excretory urography shows the kidneys. Poor development or poor development, deformation of the renal pelvis, forward displacement of the kidney and fixation of the unilateral kidney, fluoroscopy or exhalation/inhalation showed the clearest results.
Examine
Peripheral abscess examination
Laboratory examination : routine laboratory examination results are repeated and diverse, blood routine can be seen elevated white blood cells and nuclear left shift phenomenon, there are varying degrees of anemia, erythrocyte sedimentation rate increases, such as patients with other kidney disease or bilateral lesions, There may be elevated serum creatinine and blood urea nitrogen. Urine analysis has pyuria and proteinuria, but no hematuria. 30% of patients have normal fluid analysis, 40% of urine culture is negative, and only 40% have positive results in blood culture.
X-ray examination: chest, abdominal X-ray examination can not determine the diagnosis of perirenal abscess, but it is helpful for diagnosis, chest X-ray examination may find ipsilateral diaphragm elevation and fixation, pleural effusion, empyema, lung abscess Leaf infiltration and atelectasis, pneumonia scar formation, etc., abdominal X-ray examination may find scoliosis (concave to the affected side), mass, kidney stones, kidney and psoas muscle lose normal contour, kidney or kidney around the gas or kidney fixed.
Imaging examination : Most patients with perirenal abscess, excretory urography with tomography can confirm the abnormality of the affected side of the kidney, mainly manifested by poor or poor development of the affected kidney, mass, kidney displacement, renal pelvis or ureteral calculi, renal pelvis Dilatation or obstruction (with or without stones), but the above imaging characteristics are not specific manifestations of perirenal abscess.
Gallium (Ga67) citrate or indium (In111) tracer leukocyte radionuclide scans are of little diagnostic significance because they are time consuming and do not distinguish between perirenal abscesses and other kidney diseases, and renal angiography is not A specific diagnostic method for perirenal abscess because it is an invasive procedure and its results are not superior to renal ultrasound and CT scans, so arteriography is rarely used to diagnose perirenal abscesses.
Ultrasound of the kidney is a diagnostic test for perirenal abscess, but CT scan can reflect the whole lesion. CT has a soft tissue mass, and the CT value drops to 0-20H unit, without contrast enhancement. The CT value of the inflammatory abscess wall decreased slightly; after the contrast agent was injected, the density of the abscess wall increased, the surrounding tissue structure disappeared, the diseased kidney or psoas muscle expanded, the perirenal fascia thickened, and gas or gas and liquid appeared in the lesion. In the plane, percutaneous puncture under CT guidance can determine the diagnosis and identify the pathogen.
Diagnosis
Diagnosis and diagnosis of perirenal abscess
diagnosis
According to the medical history and laboratory examination data can be diagnosed.
Laboratory examination: blood routine can be seen with elevated white blood cells and left nucleus, with varying degrees of anemia, erythrocyte sedimentation rate increased by 30% in patients with normal fluid analysis, 40% urine culture negative, only 40% in blood culture Positive result.
Differential diagnosis
Need to identify with cheese hollow tuberculosis, the identification point is: this and the renal inflammatory reaction is extensive, often affecting the psoas muscle, and kidney tuberculosis less affects the psoas muscle, right perirenal abscess.
