Elsevier

European Urology

Volume 59, Issue 2, February 2011, Pages 297-299
European Urology

Case Study of the Month
Hepatorenal Polycystic Disease and Fever: Diagnostic Contribution of Gallium Citrate Ga 67 Scan and Fluorine F 18 FDG-PET/CT

https://doi.org/10.1016/j.eururo.2009.05.049Get rights and content

Abstract

A cyst infection was suspected in a patient who was on haemodialysis for renal failure secondary to hepatorenal polycystic disease with persistent fever and pain in right hypochondrium despite antibiotherapy. Radiologic exams (ultrasonography, computed tomography [CT]), however, did not show signs of infection. For surgical removal of the infected cyst, a precise location was required.

This report shows how functional imaging, gallium citrate Ga 67 scan, and fluorine F 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) revealed which cyst was infected; however, the fused image provided by PET/CT showed the precise, required location.

The infected cyst was located on the right kidney. A week later, after nephrectomy, all symptoms disappeared.

Section snippets

Case report

A 49-yr-old woman with fever and pain in the right hypochondrium was admitted for examination. Lab findings disclosed haemoglobin of 10.6 g/dl with haematocrit (Hct) of 31% and mean cell volume (VCM) of 102.9 femtolitres (fl), a white blood cell count of 8900 cells per microlitre, 86% neutrophil granulocytes, 7% lymphocytes, erythrocyte sedimentation rate of 124 mm per first hour and 4.6 mg/dl of C-reactive protein, 117 mg/dl of urea and 5.56 mg/dl of creatinine, 0.3 mg/dl of total bilirubin, and 243 

Discussion

Pyogenic abscess is a process with significant morbidity and mortality, and it is a rare complication in patients with autosomal dominant polycystic kidney disease [1]. When this situation is suspected, the first clinical step is the diagnosis. The crucial second step is to precisely locate the abscess anatomically to provide surgical treatment, especially if the causative organism or the septic focus cannot be identified or if the antibiotic therapy has failed [2]. Detection of infected cysts

EU-ACME question

Please visit www.eu-acme.org/europeanurology to answer the following EU-ACME question online (the EU-ACME credits will be attributed automatically).
Question:

A patient on haemodialysis for chronic renal failure secondary to known hepatorenal polycystic disease showed persistent fever despite treatment with antibiotics. Because a cyst infection is suspected, what would be the most appropriate diagnostic technique to identify the accurate site of the infected cyst and determine the most effective

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