Fig. 14

3-year-old girl with history of recurrent urinary tract infection and right loin pain and diagnosed as Xanthogranulomatous pyelonephritis with fistulous communication to the airway and duodenum. a Ultrasound reveals distorted renal parenchyma with multiple echogenic stones with paradoxically contracted renal pelvis. b Axial non-contrast CT reveals enlarged right kidney with multiple necrotic areas and a central stone. The inflammatory process extends to the perinephric region and right psoas muscle. c DTPA scintigraphy reveals normal uptake in the normal left kidney and no uptake in the right kidney. d Fistulography through a cutaneous opening reveals multiple fistulous tracts communicating with the bronchial tree, and duodenum (arrows)