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Published in: Pediatric Nephrology 3/2011

01-03-2011 | Original Article

Hepatic and pulmonary nodular lesions in pediatric urinary tract infections

Authors: Hyung Eun Yim, Byung Min Choi, Young Jun Rhie, Kee Hwan Yoo, Young Sook Hong, Joo Won Lee

Published in: Pediatric Nephrology | Issue 3/2011

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Abstract

One of the major goals in investigating children with urinary tract infection (UTI) is to recognize patients at risk of further UTI-related problems. This study reports the clinical features of 19 pediatric patients with UTIs in whom associated hepatic and/or pulmonary nodules were incidentally diagnosed by the imaging tests performed for the UTI. Hepatic nodules in five patients were detected on ultrasound scans, and pulmonary nodules and both hepatic and pulmonary nodules were detected in 12 and two children by dimercaptosuccinic acid scintigraphy. The mean age of the patients was 24.5 months. Vesicoureteral reflux (VUR) was detected in nine of 17 patients (52.9%), acute pyelonephritis was identified in nine of 18 patients, and renal scarring was found in 57.1% patients with pyelonephritis. On follow-up, the hepatic and/or pulmonary nodules regressed in all patients. About 85.7% of patients experienced a recurrence of UTI within 1 year. In comparison with age- and sex-matched controls with UTIs without pulmonary or hepatic nodules, the presence of VUR and the recurrence of UTI within 1 year were higher in patients with UTIs and nodules (P < 0.05). The hepatic and/or pulmonary nodules identified on the ultrasound scan and by dimercaptosuccinic acid scintigraphy may provide a valuable diagnostic marker for the proper management of patients with an UTI.
Literature
1.
go back to reference Drekonja DM, Johnson JR (2008) Urinary tract infections. Prim Care 35:345–367PubMed Drekonja DM, Johnson JR (2008) Urinary tract infections. Prim Care 35:345–367PubMed
2.
go back to reference Mori R, Lakhanpaul M, Verrier-Jones K (2007) Diagnosis and management of urinary tract infection in children: summary of NICE guidance. Br Med J 335:395–397CrossRef Mori R, Lakhanpaul M, Verrier-Jones K (2007) Diagnosis and management of urinary tract infection in children: summary of NICE guidance. Br Med J 335:395–397CrossRef
3.
go back to reference Biassoni L, Chippington S (2008) Imaging in urinary tract infections: current strategies and new trends. Semin Nucl Med 38:56–66PubMedCrossRef Biassoni L, Chippington S (2008) Imaging in urinary tract infections: current strategies and new trends. Semin Nucl Med 38:56–66PubMedCrossRef
4.
go back to reference Rossleigh MA (2009) Scintigraphic imaging in renal infections. Q J Nucl Med Mol Imaging 53:72–77PubMed Rossleigh MA (2009) Scintigraphic imaging in renal infections. Q J Nucl Med Mol Imaging 53:72–77PubMed
5.
go back to reference Ajdinović B, Jauković L, Krstić Z, Dopuda M (2008) Impact of micturating cystourethrography and DMSA renal scintigraphy on the investigation scheme in children with urinary tract infection. Ann Nucl Med 22:661–665PubMedCrossRef Ajdinović B, Jauković L, Krstić Z, Dopuda M (2008) Impact of micturating cystourethrography and DMSA renal scintigraphy on the investigation scheme in children with urinary tract infection. Ann Nucl Med 22:661–665PubMedCrossRef
6.
go back to reference Rondogianni P, Koniaris G (2004) Tc-99 m DMSA uptake by metastatic colorectal carcinoma. Clin Nucl Med 29:485–487PubMedCrossRef Rondogianni P, Koniaris G (2004) Tc-99 m DMSA uptake by metastatic colorectal carcinoma. Clin Nucl Med 29:485–487PubMedCrossRef
7.
go back to reference Camacho V, Estorch M, Fraga G, Mena E, Fuertes J, Hernández MA, Flotats A, Carrió I (2004) DMSA study performed during febrile urinary tract infection: a predictor of patient outcome? Eur J Nucl Med Mol Imaging 31:862–866PubMedCrossRef Camacho V, Estorch M, Fraga G, Mena E, Fuertes J, Hernández MA, Flotats A, Carrió I (2004) DMSA study performed during febrile urinary tract infection: a predictor of patient outcome? Eur J Nucl Med Mol Imaging 31:862–866PubMedCrossRef
8.
go back to reference Sastre JB, Aparicio AR, Cotallo GD, Colomer BF, Hernández MC, Grupo de Hospitales Castrillo (2007) Urinary tract infection in the newborn: clinical and radio imaging studies. Pediatr Nephrol 22:1735–1741PubMedCrossRef Sastre JB, Aparicio AR, Cotallo GD, Colomer BF, Hernández MC, Grupo de Hospitales Castrillo (2007) Urinary tract infection in the newborn: clinical and radio imaging studies. Pediatr Nephrol 22:1735–1741PubMedCrossRef
9.
go back to reference Moorthy I, Easty M, McHugh K, Ridout D, Biassoni L, Gordon I (2005) The presence of vesicoureteric reflux does not identify a population at risk for renal scarring following a first urinary tract infection. Arch Dis Child 90:733–736PubMedCrossRef Moorthy I, Easty M, McHugh K, Ridout D, Biassoni L, Gordon I (2005) The presence of vesicoureteric reflux does not identify a population at risk for renal scarring following a first urinary tract infection. Arch Dis Child 90:733–736PubMedCrossRef
10.
go back to reference Mucci B, Maguire B (1994) Does routine ultrasound have a role in the investigation of children with urinary tract infection? Clin Radiol 49:324–325PubMedCrossRef Mucci B, Maguire B (1994) Does routine ultrasound have a role in the investigation of children with urinary tract infection? Clin Radiol 49:324–325PubMedCrossRef
11.
go back to reference Jakobsson B, Nolstedt L, Svensson L, Söderlundh S, Berg U (1992) 99mTechnetium-dimercaptosuccinic acid scan in the diagnosis of acute pyelonephritis in children: relation to clinical and radiological findings. Pediatr Nephrol 6:328–334PubMedCrossRef Jakobsson B, Nolstedt L, Svensson L, Söderlundh S, Berg U (1992) 99mTechnetium-dimercaptosuccinic acid scan in the diagnosis of acute pyelonephritis in children: relation to clinical and radiological findings. Pediatr Nephrol 6:328–334PubMedCrossRef
12.
go back to reference Ditchfield MR, de Campo JF, Nolan TM, Cook DJ, Grimwood K, Powell HR, Sloane R, Cahill S (1994) Risk factors in the development of early renal cortical defects in children with urinary tract infection. AJR Am J Roentgenol 162:1393–1397PubMed Ditchfield MR, de Campo JF, Nolan TM, Cook DJ, Grimwood K, Powell HR, Sloane R, Cahill S (1994) Risk factors in the development of early renal cortical defects in children with urinary tract infection. AJR Am J Roentgenol 162:1393–1397PubMed
13.
go back to reference Stokland E, Hellström M, Jacobsson B, Jodal U, Sixt R (1996) Renal damage one year after first urinary tract infection: role of dimercaptosuccinic acid scintigraphy. J Pediatr 129:815–820PubMedCrossRef Stokland E, Hellström M, Jacobsson B, Jodal U, Sixt R (1996) Renal damage one year after first urinary tract infection: role of dimercaptosuccinic acid scintigraphy. J Pediatr 129:815–820PubMedCrossRef
14.
go back to reference Jakobsson B, Berg U, Svensson L (1994) Renal scarring after acute pyelonephritis. Arch Dis Child 70:111–115PubMedCrossRef Jakobsson B, Berg U, Svensson L (1994) Renal scarring after acute pyelonephritis. Arch Dis Child 70:111–115PubMedCrossRef
15.
go back to reference Panaretto K, Craig J, Knight J, Howman-Giles R, Sureshkumar P, Roy L (1999) Risk factors for recurrent urinary tract infection in preschool children. J Paediatr Child Health 35:454–459PubMedCrossRef Panaretto K, Craig J, Knight J, Howman-Giles R, Sureshkumar P, Roy L (1999) Risk factors for recurrent urinary tract infection in preschool children. J Paediatr Child Health 35:454–459PubMedCrossRef
16.
go back to reference Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW, Keren R (2007) Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA 298:179–186PubMedCrossRef Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW, Keren R (2007) Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA 298:179–186PubMedCrossRef
17.
go back to reference Piepsz A, Tamminen-Möbius T, Reiners C, Heikkilä J, Kivisaari A, Nilsson NJ, Sixt R, Risdon RA, Smellie JM, Söderborg B (1998) Five-year study of medical or surgical treatment in children with severe vesico-ureteral reflux dimercaptosuccinic acid findings. International reflux study group in Europe. Eur J Pediatr 157:753–758PubMedCrossRef Piepsz A, Tamminen-Möbius T, Reiners C, Heikkilä J, Kivisaari A, Nilsson NJ, Sixt R, Risdon RA, Smellie JM, Söderborg B (1998) Five-year study of medical or surgical treatment in children with severe vesico-ureteral reflux dimercaptosuccinic acid findings. International reflux study group in Europe. Eur J Pediatr 157:753–758PubMedCrossRef
18.
go back to reference Philips RL (1994) Computed tomography and ultrasound in the diagnosis and treatment of liver abscesses. Australas Radiol 38:165–169PubMedCrossRef Philips RL (1994) Computed tomography and ultrasound in the diagnosis and treatment of liver abscesses. Australas Radiol 38:165–169PubMedCrossRef
19.
go back to reference Elsayes KM, Narra VR, Yin Y, Mukundan G, Lammle M, Brown JJ (2005) Focal hepatic lesions: diagnostic value of enhancement pattern approach with contrast-enhanced 3D gradient-echo MR imaging. Radiographics 25:1299–1320PubMedCrossRef Elsayes KM, Narra VR, Yin Y, Mukundan G, Lammle M, Brown JJ (2005) Focal hepatic lesions: diagnostic value of enhancement pattern approach with contrast-enhanced 3D gradient-echo MR imaging. Radiographics 25:1299–1320PubMedCrossRef
20.
go back to reference Koea JB, Broadhurst GW, Rodgers MS, McCall JL (2003) Inflammatory pseudotumor of the liver: demographics, diagnosis, and the case for nonoperative management. J Am Coll Surg 196:226–235PubMedCrossRef Koea JB, Broadhurst GW, Rodgers MS, McCall JL (2003) Inflammatory pseudotumor of the liver: demographics, diagnosis, and the case for nonoperative management. J Am Coll Surg 196:226–235PubMedCrossRef
21.
go back to reference Ogawa T, Yokoi H, Kawarada Y (1998) A case of inflammatory pseudotumor of the liver causing elevated serum CA19-9 levels. Am J Gastroenterol 93:2551–2555PubMedCrossRef Ogawa T, Yokoi H, Kawarada Y (1998) A case of inflammatory pseudotumor of the liver causing elevated serum CA19-9 levels. Am J Gastroenterol 93:2551–2555PubMedCrossRef
22.
go back to reference Yamaguchi J, Sakamoto Y, Sano T, Shimada K, Kosuge T (2007) Spontaneous regression of inflammatory pseudotumor of the liver: report of three cases. Surg Today 37:525–529PubMedCrossRef Yamaguchi J, Sakamoto Y, Sano T, Shimada K, Kosuge T (2007) Spontaneous regression of inflammatory pseudotumor of the liver: report of three cases. Surg Today 37:525–529PubMedCrossRef
23.
go back to reference Di Vita G, Soresi M, Patti R, Carroccio A, Leo P, Franco V, Montalto G (2001) Concomitant inflammatory pseudotumor of the liver and spleen. Liver 21:217–222PubMedCrossRef Di Vita G, Soresi M, Patti R, Carroccio A, Leo P, Franco V, Montalto G (2001) Concomitant inflammatory pseudotumor of the liver and spleen. Liver 21:217–222PubMedCrossRef
24.
25.
go back to reference Lim JH, Lee JH (1995) Inflammatory pseudotumor of the liver. Ultrasound and CT features. Clin Imaging 19:43–46PubMedCrossRef Lim JH, Lee JH (1995) Inflammatory pseudotumor of the liver. Ultrasound and CT features. Clin Imaging 19:43–46PubMedCrossRef
26.
go back to reference Seki S, Kitada T, Sakaguchi H, Iwai S, Hirohashi K, Higaki I, Nakamura K, Wakasa K, Kinoshita H (2004) A clinicopathological study of inflammatory pseudotumors of the liver with special reference to vessels. Hepatogastroenterology 51:1140–1143PubMed Seki S, Kitada T, Sakaguchi H, Iwai S, Hirohashi K, Higaki I, Nakamura K, Wakasa K, Kinoshita H (2004) A clinicopathological study of inflammatory pseudotumors of the liver with special reference to vessels. Hepatogastroenterology 51:1140–1143PubMed
27.
go back to reference Coffin CM, Watterson J, Priest JR, Dehner LP (1995) Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor). A clinicopathologic and immunohistochemical study of 84 cases. Am J Surg Pathol 19:859–872PubMedCrossRef Coffin CM, Watterson J, Priest JR, Dehner LP (1995) Extrapulmonary inflammatory myofibroblastic tumor (inflammatory pseudotumor). A clinicopathologic and immunohistochemical study of 84 cases. Am J Surg Pathol 19:859–872PubMedCrossRef
28.
go back to reference Yao X, Alvarado Y, Brackeen J, Jumper C, Cobos E (2007) Plasma cell granuloma: a case report of multiple lesions in the lung and review of the literature. Am J Med Sci 334:402–406PubMedCrossRef Yao X, Alvarado Y, Brackeen J, Jumper C, Cobos E (2007) Plasma cell granuloma: a case report of multiple lesions in the lung and review of the literature. Am J Med Sci 334:402–406PubMedCrossRef
29.
go back to reference Kim TS, Han J, Kim GY, Lee KS, Kim H, Kim J (2005) Pulmonary inflammatory pseudotumor (inflammatory myofibroblastic tumor): CT features with pathologic correlation. J Comput Assist Tomogr 29:633–639PubMedCrossRef Kim TS, Han J, Kim GY, Lee KS, Kim H, Kim J (2005) Pulmonary inflammatory pseudotumor (inflammatory myofibroblastic tumor): CT features with pathologic correlation. J Comput Assist Tomogr 29:633–639PubMedCrossRef
30.
go back to reference Melloni G, Carretta A, Ciriaco P, Arrigoni G, Fieschi S, Rizzo N, Bonacina E, Augello G, Belloni PA, Zannini P (2005) Inflammatory pseudotumor of the lung in adults. Ann Thorac Surg 79:426–432PubMedCrossRef Melloni G, Carretta A, Ciriaco P, Arrigoni G, Fieschi S, Rizzo N, Bonacina E, Augello G, Belloni PA, Zannini P (2005) Inflammatory pseudotumor of the lung in adults. Ann Thorac Surg 79:426–432PubMedCrossRef
31.
go back to reference Agrons GA, Rosado-de-Christenson ML, Kirejczyk WM, Conran RM, Stocker JT (1998) Pulmonary inflammatory pseudotumor: radiologic features. Radiology 206:511–518PubMed Agrons GA, Rosado-de-Christenson ML, Kirejczyk WM, Conran RM, Stocker JT (1998) Pulmonary inflammatory pseudotumor: radiologic features. Radiology 206:511–518PubMed
32.
go back to reference Pandya K, Wilcox J, Khaw H, Cleveland D, Sharma OP (1990) Lung abscess secondary to xanthogranulomatous pyelonephritis. Thorax 45:297–299PubMedCrossRef Pandya K, Wilcox J, Khaw H, Cleveland D, Sharma OP (1990) Lung abscess secondary to xanthogranulomatous pyelonephritis. Thorax 45:297–299PubMedCrossRef
33.
go back to reference O’Brien JD, Ettinger NA (1995) Nephrobronchial fistula and lung abscess resulting from nephrolithiasis and pyelonephritis. Chest 108:1166–1168PubMedCrossRef O’Brien JD, Ettinger NA (1995) Nephrobronchial fistula and lung abscess resulting from nephrolithiasis and pyelonephritis. Chest 108:1166–1168PubMedCrossRef
34.
go back to reference Wang SJ, Lin WY, Wey SP, Shen LH, Ting G (1999) Pentavalent Tc-99 m dimercaptosuccinic acid imaging of hepatocellular carcinoma. Neoplasma 46:246–248PubMed Wang SJ, Lin WY, Wey SP, Shen LH, Ting G (1999) Pentavalent Tc-99 m dimercaptosuccinic acid imaging of hepatocellular carcinoma. Neoplasma 46:246–248PubMed
35.
go back to reference Ergün EL, Kara PO, Gedik GK, Kars A, Türker A, Caner B (2007) The role of Tc-99 m (V) DMSA scintigraphy in the diagnosis and follow-up of lung cancer lesions. Ann Nucl Med 21:275–283PubMedCrossRef Ergün EL, Kara PO, Gedik GK, Kars A, Türker A, Caner B (2007) The role of Tc-99 m (V) DMSA scintigraphy in the diagnosis and follow-up of lung cancer lesions. Ann Nucl Med 21:275–283PubMedCrossRef
36.
go back to reference Lee BF, Chiu NT, Wu DC, Tsai KB, Liu GC, Yu HS, Wang ST (2001) Use of 99mTc (V) DMSA scintigraphy in the detection and localization of intestinal inflammation: comparison of findings and colonoscopy and biopsy. Radiology 220:381–385PubMed Lee BF, Chiu NT, Wu DC, Tsai KB, Liu GC, Yu HS, Wang ST (2001) Use of 99mTc (V) DMSA scintigraphy in the detection and localization of intestinal inflammation: comparison of findings and colonoscopy and biopsy. Radiology 220:381–385PubMed
37.
go back to reference Balci TA, Ciftci I, Karaoglu A (2006) Incidental DTPA and DMSA uptake during renal scanning in unknown bone metastases. Ann Nucl Med 20:365–369PubMedCrossRef Balci TA, Ciftci I, Karaoglu A (2006) Incidental DTPA and DMSA uptake during renal scanning in unknown bone metastases. Ann Nucl Med 20:365–369PubMedCrossRef
38.
go back to reference Ohta H, Ishii M, Yoshizumi M, Endo K, Sakahara H, Nakajima T, Yomoda I, Masuda H, Horiuchi K, Hata N (1985) A comparison of the tumor-seeking agent Tc-99 m(V) dimercaptosuccinic acid and the renal imaging agent Tc-99 m dimercaptosuccinic acid in humans. Clin Nucl Med 10:167–170PubMedCrossRef Ohta H, Ishii M, Yoshizumi M, Endo K, Sakahara H, Nakajima T, Yomoda I, Masuda H, Horiuchi K, Hata N (1985) A comparison of the tumor-seeking agent Tc-99 m(V) dimercaptosuccinic acid and the renal imaging agent Tc-99 m dimercaptosuccinic acid in humans. Clin Nucl Med 10:167–170PubMedCrossRef
39.
go back to reference Evans JA, Meyers MA, Bosniak MA (1971) Acute renal and perirenal infections. Semin Roentgenol 6:276–291PubMedCrossRef Evans JA, Meyers MA, Bosniak MA (1971) Acute renal and perirenal infections. Semin Roentgenol 6:276–291PubMedCrossRef
40.
go back to reference Kahan MG, Tilney NL (1972) Hepatic abscess produced by extension of a perinephric abscess. Am J Surg 124:687–689PubMedCrossRef Kahan MG, Tilney NL (1972) Hepatic abscess produced by extension of a perinephric abscess. Am J Surg 124:687–689PubMedCrossRef
Metadata
Title
Hepatic and pulmonary nodular lesions in pediatric urinary tract infections
Authors
Hyung Eun Yim
Byung Min Choi
Young Jun Rhie
Kee Hwan Yoo
Young Sook Hong
Joo Won Lee
Publication date
01-03-2011
Publisher
Springer-Verlag
Published in
Pediatric Nephrology / Issue 3/2011
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-010-1706-8

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