Hayes W S, Hartman D S, Sesterbenn I A
Department of Radiology, Georgetown University Hospital, Washington, DC 20007-2197.
Radiographics. 1991 May;11(3):485-98. doi: 10.1148/radiographics.11.3.1852939.
Xanthogranulomatous pyelonephritis is a form of chronic infection of the kidney and surrounding tissues characterized by destruction and replacement of renal parenchyma by lipid-laden macrophages. Gross pathologic features include massive renal enlargement, lithiasis, peripelvic fibrosis, hydronephrosis, and lobulated yellow masses replacing renal parenchyma. Typically, the disease is diffuse and has characteristic imaging features. Less commonly, the process is focal and is difficult to differentiate from malignant disease on radiologic studies. Ultrasound demonstrates renal enlargement with multiple anechoic or hypoechoic masses replacing the normal corticomedullary differentiation and a contracted pelvis. Peripelvic fibrosis may obscure acoustic shadowing from a central staghorn calculus. On computed tomographic scans, a staghorn calculus may be seen in a contracted renal pelvis of an enlarged kidney, with characteristic low-attenuation, peripherally enhancing rounded masses. Extrarenal extension of the inflammatory process is frequently seen.
黄色肉芽肿性肾盂肾炎是一种肾脏及周围组织的慢性感染形式，其特征是肾实质被充满脂质的巨噬细胞破坏和取代。大体病理特征包括肾脏显著增大、结石形成、肾盂周围纤维化、肾积水以及取代肾实质的分叶状黄色肿块。通常，该疾病呈弥漫性，具有特征性的影像学表现。较少见的情况下，病变呈局灶性，在影像学检查中难以与恶性疾病相鉴别。超声显示肾脏增大，多个无回声或低回声肿块取代了正常的皮质髓质分界，肾盂缩小。肾盂周围纤维化可能会掩盖中心鹿角形结石的声影。在计算机断层扫描中，可见增大的肾脏缩小的肾盂内有鹿角形结石，伴有特征性的低密度、周边强化的圆形肿块。炎症过程常可见肾外扩展。
