CTICasesXanthogranulomatous Pyelonephritis and Metastatic Sarcoma
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Imaging findings
Abdominal CT shows xanthogranulomatous pyelonephritis of the left kidney with obstructing calculi, cortical destruction, and inflammatory extension superiorly through the diaphragmatic crus into the left pleural space and lower lobe. Chest CT additionally demonstrates multiple nodular, pleural-based, and cystic parenchymal lesions, which were biopsied and proven to represent metastatic sarcoma from a known thigh primary.
Key takeaways
Xanthogranulomatous pyelonephritis is a severe chronic inflammatory renal infection that can breach the renal capsule and spread transdiaphragmatically into the pleural space and lung. However, when multiple scattered pleural or cystic nodules are present, a history of malignancy must be considered, as extremity sarcomas are notorious for presenting with atypical, cystic, or pleural-based lung metastases.
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