Nandwani G M, Biyabani S R, Memon A.
Incidental intrarenal-pelvic Hydatid Cyst discovered during Percutaneous Nephrolithotomy (PCNL).
J Pak Med Assoc Jan ;54(8):436-8.

A 32-years old housewife presented with left lumbar pain and hematuria for 6 months. On examination she had moderate tenderness in left lumbar region. Laboratory investigations revealed hemoglobin: 12.5 gm/dl, white cell count: 11.1 x 10E9 per liter, neutrophils: 74.9%, sodium: 143 mmol/ L, potassium 3.9 mmol/L, creatinine: 0.7 mg/dl, calcium: 9.6 mg/dl, phosphorous: 2.8 mg/dl, urinalysis showed red blood cells: 2 and leukocytes: 18 per high power field. Urine culture showed growth of Proteus mirabilis. Intravenous urogram and ultrasound kidneys showed a 3cm radio opaque calculus in the left renal pelvis with multiple small daughter calculi with evidence of partial obstruction leading to moderate hydronephrosis. After treating the urinary tract infection, she underwent a PCNL for her renal stones. At surgery multiple flimsy membranous structures embedded in gelatinous material along with small mushy stones and debris was found that raised suspicion of renal hydatid disease. Histopathology revealed extensively calcified cystic tissue, lamellations and focal necrosis of surrounding tissue. Echinococcal antibody titers were <1:16 (normal <1:32). She was put on albendazole treatment regimen and ultrasound abdomen repeated after 10 months showed no recurrence of cyst.

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