Kyaw Min, Sunita Devi, Prema Sadasivam
We report the case of a 13-year-old Malay boy, known to have thalassemia Hb H, who presented with right loin pain for 2 weeks, fever off and on, dysuria and tenderness of the right renal angle. Initial imaging by ultrasound and CT scan revealed “a right upper pole renal mass with vascularization; possibilities include Wilm’s tumor, metanephric adenoma or cystic partially differentiated nephroblastoma”. A repeat ultrasound scan, performed one week later revealed extension of the lesion to the mid-pole and the evolution was “more suggestive of focal lobar nephronia with necrosis and microabscess formation, mimicking a renal mass/tumour”. Acute lobar nephronia was diagnosed and IV Ceftriaxone 1.5 Gm OD was administered for 14 days. Repeat ultrasonography revealed that the lesion had resolved in the upper pole and limited to being a much smaller lesion at the midpole of the right kidnay. Acute lobar nephronia should be considered in all cases with fever, flank pain and a renal mass-lesion on ultrasonography.
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