Cancelinha Candida, Santos Lea, Ferreira Carmen, Gomes Clara
Department of Hospital Pediátrico, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.
BMJ Case Rep. 2014 Mar 26;2014:bcr2013202408. doi: 10.1136/bcr-2013-202408.
Renal abscesses are rare conditions in children, but they must be remembered in differential diagnosis of fever and abdominal pain. The authors report two paediatric cases with unusual presentation. Case 1: a 15-year-old girl was admitted following a period of fever, vomiting and left hypochondrium pain which became more localised to the left lower ribs. Blood tests suggested bacterial infection, but urinalysis and culture were negative. Renal CT scan presented features of bilateral pyelonephritis and left renal abscesses, while ultrasound remained normal until the ninth day of disease. Case 2: a 2-year-old girl, with diagnosis of β-thalassemia minor, had intermittent diffuse abdominal pain with 2 weeks of evolution. Renal ultrasonography and CT scan showed a heterogeneous mass compatible with Willms tumour. Intraoperative diagnosis was compatible with renal abscess with isolation of Proteus mirabilis in the fluid. Both responded well to long-term antibiotics and to surgical drainage (in the second case).
肾脓肿在儿童中较为罕见，但在发热和腹痛的鉴别诊断中必须予以考虑。作者报告了两例表现不寻常的儿科病例。病例1：一名15岁女孩在经历一段时间的发热、呕吐和左季肋部疼痛后入院，疼痛后来更局限于左下腹肋骨处。血液检查提示细菌感染，但尿液分析和培养均为阴性。肾脏CT扫描显示双侧肾盂肾炎和左肾脓肿的特征，而超声在疾病第9天前一直正常。病例2：一名2岁女孩，诊断为轻型β地中海贫血，有持续2周的间歇性弥漫性腹痛。肾脏超声检查和CT扫描显示一个与肾母细胞瘤相符的不均匀肿块。术中诊断为肾脓肿，液体中分离出奇异变形杆菌。两例患者对长期抗生素治疗及（第二例患者的）手术引流均反应良好。
