A Nautilus kidney

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Abstract
We report a 71-year-old woman who presented with unilateral flank pain and sepsis. A computed tomographic (CT) scan demonstrated left-sided hydronephrosis. Subsequent percutaneous nephrotomy drainage showed pus-like material, confirming the diagnosis of pyonephrosis. The ureteral stricture was caused by previous radiation injury for cervical cancer in this ESRD patient who was on chronic dialysis for years. In our case, the grade IVB hydronephrosis is a result of an extremely atrophic kidney, pyonephrosis, and ureteral stricture. The CT section of pyonephrosis in an extremely atrophic kidney resembles a sagittal section of a Nautilus shell, as the shell corresponds to the diffusely thinned renal cortex.
Funding Information
  • National Yang-Ming University (Yin Yen-Liang Development and Construction Plan (107F-M01-0504))
  • Ministry of Science and Technology, Taiwan (MOST 108-2633-B-009-001)
  • Taipei Veterans General Hospital (V106D25-003-MY3, VGHUST109-V5-1-2)
  • Ministry of Education (Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B))