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Fig. 1 | BMC Infectious Diseases

Fig. 1

From: Two cases of fungal cyst infection in ADPKD: is this really a rare complication?

Fig. 1

A prior study [11] revealed that ultrasound, CT and magnetic resonance imaging (MRI) failed to detect the infected cysts in 94, 82 and 60% of the cases, respectively. PET-CT, on the other hand, showed sensitivity of 100% on the basis of FDG uptake by inflammatory cells. Such data are in agreement with a previous report of ours [10]. Both of our cases support such a diagnostic capacity of PET-CT. a Non-contrasted computed tomography (CT) scan on coronal view shows no evidence of cyst infection. Some cysts present higher density, a finding suggestive of recent hemorrhage (red arrow); b Positron emission tomography–computed tomography imaging: coronal section analysis reveals increased cyst-lining 18-FDG uptake activity (blue arrows), a very suggestive finding of cyst infection; c Gross appearance of the right kidney after nephrectomy. This enlarged kidney presented multiple medium and large-sized cysts filled with pus (yellow arrows) or blood (red arrows); Histologic analysis of kidney section evidenced d an area of inflammatory cavitation, centered on urinary tract and adjacent to some cysts on the left superior field (hematoxylin-eosin, × 4 obj.); e Kidney parenchyma with neutrophilic interstitial infiltration, acute tubular damage and tubular neutrophilic casts (hematoxylin-eosin, × 20 obj.); f Numerous septate hyphae and yeast microorganisms with morphological features of Candida sp., positively stained by Grocott’s methenamine silver (× 100 obj.); g Sagital view of enlarged kidneys with multiple cysts containing homogeneous liquid or heterogeneous dense hyperproteic material; h Imaging assessment reveals perirenal fascia thickening and high FDG uptake in an exophytic cyst (blue arrow), yielding the diagnosis of renal cyst infection

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