Snoj Ziga, Savic Nenad, Regvat Jaka
Radiology Institute, University Medical Centre, Zaloška 2, Ljubljana, Slovenia.
Int Braz J Urol. 2015 Jul-Aug;41(4):808-12. doi: 10.1590/S1677-5538.IBJU.2014.0541.
Kidney disease presenting with cutaneous fistula is a rare condition. We present a case of a 90-year-old woman with dementia who had no prior urological problems and had a cutaneous fistula in the left lumbar region. A fistulogram and computer tomography examination revealed a large staghorn calculus with signs of xanthogranulomatous pyelonephritis in the left kidney and renal fistulisation to the psoas muscle, skin and bronchi. To our knowledge this is the first report in the literature of coexisting renal fistulisation to the psoas major muscle, skin and bronchi. This report illustrates how computed tomography in combination with fistulography can resolve the diagnostic dilemma that pertains to the complex spread of the disease in cases involving nephrocutaneous fistula. Furthermore, the report shows how a renal calculus, even asymptomatic, can cause a serious medical condition, and highlights the importance of early medical intervention.
以皮肤瘘为表现的肾脏疾病是一种罕见病症。我们报告一例90岁患有痴呆症的女性病例，该患者既往无泌尿系统问题，左侧腰部出现皮肤瘘。瘘管造影和计算机断层扫描检查显示左肾有一枚巨大鹿角形结石，伴有黄色肉芽肿性肾盂肾炎迹象，且肾脏与腰大肌、皮肤及支气管形成瘘管。据我们所知，这是文献中首例肾脏与腰大肌、皮肤及支气管同时存在瘘管形成的报告。本报告说明了计算机断层扫描结合瘘管造影如何解决涉及肾皮肤瘘病例中疾病复杂蔓延所带来的诊断难题。此外，该报告还展示了即使无症状的肾结石也可导致严重病症，并强调了早期医学干预的重要性。
