Case 1
History:
44 year old male with chronic urinary infection
Findings:
CT showing diffuse right renal cortical thinning with large renal stone and significant surrounding fatty tissue resulting in mass effect upon the adjacent structures.
Diagnosis:
Replacement lipomatosis.
Discussion:
Replacement lipomatosis of the kidney, also known as replacement fibrolipomatosis, is typically a unilateral process associated with chronic infection, long-term hydronephrosis, and calculi with renal parenchymal atrophy. Renal calculi associated with inflammatory changes is found in more than 70% of cases. The kidney usually is enlarged with fibrofatty appearance and cortical atrophy.
The affected kidney is often poorly functioning or non-functioning kidney.
Clinical symptoms, including urinary tract infections, fever, and flank pain, usually result from the associated inflammatory and calculous disease.
References:
- Young HH. Lipomatosis or destructive fat replacement of the renal cortex. J Urol 1933; 29:631-644.
- Gildenhorn HL. Renal replacement lipomatosis: review and case report. JAMA 1962; 181:994-996.
- Ambos MA, Bosniak MA, Gordon R, Madayag MA. Replacement lipomatosis of the kidney. AJR Am J Roentgenol 1978; 130:1087-1091.
- Hurwitz RS, Benjamin JA, Cooper JF. Excessive proliferation of peripelvic fat of the kidney. Urology 1978; 11:448-456.
- Honda H, McGuire CW, Barloon TJ, Hashimoto K. Replacement lipomatosis of the kidney: CT features. J Comput Assist Tomogr 1990; 14:229-231.
- Kullendorff B, Nyman V, Aspelin P. Computed tomography in renal replacement lipomatosis. Acta Radiol 1987; 28:447-450
