What is marked in red is severe hydronephrosis with probable pyonephrosis or dysplastic multicystic kidney.

الاحتباس مش دايما بيتقسطر بسهولة وبتحتاج ساعات تركب قسطرة فوق العانة Intractable hematuria Torsion Priapism Urethral stone Pyonephrosis ممكن يحتاج تركب قساطر كلوية AKI due to postrenal cause بيحتاج تركب دعامات او تركب قساطر كلوية بس هتفضل كام سنة في حياتك تشتغل طوارئ يعني

youtu.be/sK-zbEOKMss?si=Gmt1… A challenging and important learning point in pediatric urology. When PUJO and VUJO coexist, missing the distal obstruction can lead to serious postoperative complications. In this infant case, only PUJO was identified initially and an open pyeloplasty was performed elsewhere based on ultrasound findings. However, the associated UVJO was missed. After stent removal, the child presented with pyonephrosis. Emergency PCN was performed, and subsequent nephrostogram demonstrated complete cut-off at the UVJ. We proceeded with robotic ureteric reimplantation, and the child recovered well. This case highlights the importance of evaluating the entire urinary drainage pathway before intervention. In combined obstruction cases, distal obstruction should generally be addressed first. Video: Infant Robotic Reimplantation Case youtu.be/sK-zbEOKMss?si=Gmt1… #RoboticSurgery #PediatricUrology #Urology #RoboticUrology #PUJO #UVJO #Pyeloplasty #UretericReimplantation #InfantSurgery #MinimallyInvasiveSurgery #Hydronephrosis #Pyonephrosis #PreetiUrology #DrChandraMohanVaddi #AssociationOfSouthernUrologists

XGP & Pyonephrosis ➡ Primary Diagnosis: The most likely cause of sepsis is Xanthogranulomatous Pyelonephritis (XGP) or pyonephrosis. ➡ Etiology: Sepsis is secondary to an obstructive renal calculus leading to severe, chronic infection. ➡ Radiographic Clues: Renal Mass: Significant enlargement of the left renal shadow. Psoas Sign: Loss of the left psoas margin, indicating retroperitoneal inflammation. Infection Evidence: Presence of gas-containing areas suggesting gas-forming organisms. Calculi: Visible urinary tract calcifications supporting obstructive uropathy. ➡ Pathophysiology: Chronic obstruction causes urinary stasis, leading to destruction of renal parenchyma and suppurative inflammation. ➡ Microbiology: Typically associated with Proteus or E. coli. ➡ High-Yield Pearl: A CT scan would classically reveal the "Bear Paw Sign," which is pathognomonic for XGP.

Most likely cause of sepsis: Xanthogranulomatous pyelonephritis (XGP) / pyonephrosis secondary to obstructive renal calculus 🪨🦠 📌 Key radiographic clues: • Enlarged left renal shadow/mass • Loss of the left psoas margin → retroperitoneal inflammation • Gas-containing appearance suggesting severe infection with gas-forming organisms • Associated urinary tract calcification supporting obstructive uropathy 🧠 Pathophysiology: Chronic urinary obstruction causes: → urinary stasis → recurrent infection → destruction of renal parenchyma → suppurative inflammation and sepsis ⚠️ Common organisms: • Proteus • E. coli 📚 High-yield pearl: CT classically demonstrates the “Bear Paw Sign” in XGP. ✅ Most likely diagnosis: Sepsis secondary to infected obstructed kidney (XGP/pyonephrosis).

Most likely cause of sepsis: Xanthogranulomatous pyelonephritis (XGP) / pyonephrosis secondary to obstructive renal calculus 🪨🦠 📌 Key radiographic clues: • Enlarged left renal shadow/mass • Loss of the left psoas margin → retroperitoneal inflammation • Gas-containing appearance suggesting severe infection with gas-forming organisms • Associated urinary tract calcification supporting obstructive uropathy 🧠 Pathophysiology: Chronic urinary obstruction causes: → urinary stasis → recurrent infection → destruction of renal parenchyma → suppurative inflammation and sepsis ⚠️ Common organisms: • Proteus • E. coli 📚 High-yield pearl: CT classically demonstrates the “Bear Paw Sign” in XGP. ✅ Most likely diagnosis: Sepsis secondary to infected obstructed kidney (XGP/pyonephrosis).

Pyonephrosis

GROSS PYONEPHROSIS.

Here is the Arabic text you can overlay on your infographic (clean, exam-focused, ready for your #MedEd posts 👇): 🟠 فغر الكلية عبر الجلد ثنائي الجانب (Bilateral Percutaneous Nephrostomy) 🧠 ما هو الإجراء؟ إجراء تدخلي يتم فيه إدخال قساطر عبر الجلد إلى حوض الكلية لتصريف البول في حالات انسداد الجهاز البولي. 📌 متى يُستخدم؟ ✔ انسداد الحالب (حصوات، أورام، تضيّق) ✔ فشل كلوي انسدادي (Obstructive uropathy) ✔ موه الكلية الشديد (Hydronephrosis) ✔ إنتان بولي مع انسداد (Pyonephrosis – حالة طارئة) ⚙️ كيف يتم؟ ✔ تحت توجيه الأشعة (Ultrasound / Fluoroscopy) ✔ إدخال القسطرة عبر الخاصرة إلى حوض الكلية ✔ يتم التصريف إلى كيس خارجي ✔ غالبًا تحت تخدير موضعي 🔑 معلومات مهمة ✔ ثنائي (Bilateral) = كلا الكليتين ✔ عبر الجلد (Percutaneous) = من خلال الجلد ✔ Nephrostomy = تصريف مباشر من الكلية ⚠️ المضاعفات المحتملة ⚠ نزيف ⚠ عدوى ⚠ انسداد أو انزلاق القسطرة ⚠ تسرب البول حول القسطرة 💡 Pearl (معلومة ذهبية) 👉 إجراء منقذ للحياة في حالات الانسداد مع الإنتان 👉 يجب عدم تأخير التصريف في pyonephrosis

A 72-year-old diabetic patient presents with fever, hypotension, and confusion. Labs: Lactate: 5 mmol/L WBC: 19,000 CT abdomen shows obstructed infected kidney (pyonephrosis). Despite fluids and antibiotics, the patient remains hypotensive. What is the most important next step? A. Add vancomycin B. Start vasopressors C. Urgent urinary drainage D. Repeat CT scan E. Dialysis

A. Malecot's catheter. • It is a self‑retaining drainage tube with a characteristic mushroom/flower‑shaped winged tip used mainly for suprapubic cystostomy and nephrostomy. ∆ Main uses-: • Suprapubic cystostomy for bladder outlet obstruction, urethral injury, urethral stricture, neurogenic bladder. • Percutaneous nephrostomy for upper urinary tract obstruction, post‑PCNL drainage, pyonephrosis.. ∆ Advantages-: • Wide lumen and winged tip allow efficient drainage of thick viscous fluids (pus, clots) compared with Foley. • Good retention with low risk of accidental dislodgement when correctly positioned.

Acute urinary retention Hematuria Ureteric stone Obstructing stone with infection Pyonephrosis Hydronephrosis Acute pyelonephritis Urosepsis Acute bacterial prostatitis Epididymo-orchitis Fournier’s gangrene Testicular torsion Scrotal abscess فيه اشياء كثير بس هذي ال most common

Moderate is fair But the fluid content is echo rich , mostly likely infected and now pyonephrosis

#DailyUltrasoundCase ☢️ Tuberculous Pyelonephritis ⏩️ Definition Tuberculous pyelonephritis (renal tuberculosis) is infection of the renal parenchyma and collecting system by Mycobacterium tuberculosis, usually via hematogenous spread. It causes granulomas, necrosis, cavitation, fibrosis, and calcification. It represents 15–20% of extrapulmonary TB cases and is common in high-burden regions like sub-Saharan Africa. ⏩️ Symptoms Hematuria (often microscopic) Dysuria and increased frequency Flank pain or loin tenderness Fever, weight loss, night sweats, malaise Signs of obstruction or renal failure in advanced disease ⏩️ Risk Factors / Etiology Infectious spread: Hematogenous from pulmonary TB, reactivation years later Demographics: Young adults (20–40), more in males, common in Africa Immunocompromise: HIV co-infection, diabetes, malnutrition, steroids Socioeconomic: Overcrowding, poor sanitation, limited access to care Other: Genetic predisposition, close TB contact ☢️ Sonographic Features Early: Normal kidneys or small cortical hypoechoic lesions; calcifications with shadowing Progressive: Papillary necrosis (echogenic non-shadowing masses) Cavitary hypoechoic lesions communicating with collecting system Pelvic/ureteric wall thickening Pyonephrosis (debris-filled dilatation) Advanced: Shrunken kidneys with thinned cortex Dense calcifications (“putty kidney”) Hydronephrosis from strictures Associated bladder wall thickening Color Doppler: Reduced flow in necrotic areas, hyperemia in active inflammation🔚

Gross pyonephrosis is secondary to obstructing calculus at uretero pelvic junction.

🛑 A nephrostomy is a procedure where a thin tube (called a nephrostomy tube) is inserted through the skin into the kidney to drain urine directly from the kidney. ♦️Indications : 🔶️It's done when urine flow is blocked and can't pass from the kidney to the bladder, such as in: 🔷️Kidney stones (obstructing the ureter) 🔷️Tumors (bladder, cervix, or colon) 🔷️Infections with pus buildup (pyonephrosis) 🔷️Ureteric injury or stricture 🔷️Congenital anomalies (in children).

🚩Silent Pyonephrosis

Pyonephrosis.

Both kidneys : Normal site, enlarged in size up to 14x8 cm , irregular shape, lost parenchymal thickness and increased echogenecity-,no masses . There is marked back pressure changes with turbidity and internal echo suggesting pyonephrosis #ultrasound #sonologist