The Lateral Pyelogram as a Diagnostic AId in Perinephric Abscess

Perinephric abscess is an age old condition recognized as a clinical entity for many years, yet it remains undiagnosed in a large percentage of cases. In diagnosis this condition may be confused with traumatic rupture of the kidney, pyonephrosis, nephrolithiasis, renal or perirenal tumors, lumbar arthritis, lumbar hernia, retrocecal appendicitis, subdiaphragmatic abscess, gallbladder disease, tuberculosis of the spine or hip, osteomyelitis of the ribs or a ruptured viscus. Consequently, any patient with a history of chills, fever or lumbar pain and presenting tenderness of the costomuscular angle, leukocytosis and rigidity of the lumbar and psoas muscles should undergo a complete urologic examination. In 1921 Bela Alexander1of Leipzig reported two cases of perinephric abscess showing a disappearance of the psoas line and a poorly defined kidney outline on the affected side; in one of the cases there was a curvature of the spine and a retraction of the thigh.