Korean J Urol.  2010 Mar;51(3):216-218.

An Aspergilloma Mistaken for a Pelviureteral Stone on Nonenhanced CT: A Fungal Bezoar Causing Ureteral Obstruction

• Lee SW

Abstract

Fungus balls rarely cause upper urinary tract obstruction, and they are most often found in patients with diabetes mellitus or impaired immunity. The computed tomography (CT) findings of fungal bezoars of the urinary tract are nonspecific and have rarely been described, while in most cases, radiolucent filling defects are observed on excretory or retrograde urography. Here, an unusual case of an aspergilloma causing ureteral obstruction is presented; it was initially mistaken for a pelviureteral stone on nonenhanced CT.

Keyword

Aspergillosis; Spiral computed tomography; Ureteral obstruction

MeSH Terms

Aspergillosis
Bezoars
Diabetes Mellitus
Fungi
Humans
Tomography, Spiral Computed
Ureter
Ureteral Obstruction
Urinary Tract
Urography

Figure

• 

  FIG. 1 Nonenhanced computed tomography (CT) of the abdomen showing the 7 cm dumbbell-shaped lesion (black arrow) with areas of high attenuation in the dilated right renal pelvis and upper ureter. (A) An axial CT image. (B) A coronal CT image.

• 

  FIG. 2 (A) Gross specimen of the removed fungus ball, which had a putty-like consistency. (B) A histopathological section of the specimen showing fungal hyphae with septation, parallel walls, and branching at acute angles, suggestive of Aspergillus (H&E, ×100).

Reference

1. Irby PB, Stoller ML, McAninch JW. Fungal bezoars of the upper urinary tract. J Urol. 1990. 143:447–451.

2. Kueter JC, MacDiarmid SA, Redman JF. Anuria due to bilateral ureteral obstruction by Aspergillus flavus in an adult male. Urology. 2002. 59:601.

3. Ku JH, Kim DS, Kim JM, Kim YH, Jeon YS, Lee NK. A case of anuria and urinary ascites in a premature infant due to bilateral ureteropelvic fungal bezoars. Korean J Urol. 1999. 40:1558–1562.

4. Pérez-Arellano JL, Angel-Moreno A, Belón E, Francès A, Santana OE, Martín-Sánchez AM. Isolated renoureteric aspergilloma due to Aspergillus flavus: case report and review of the literature. J Infect. 2001. 42:163–165.

5. Bhayani SB, Siegel CL. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Urinary tract imaging: basic principles. Campbell-Walsh urology. 2007. 9th ed. Philadelphia: Saunders;127–135.

6. el Fakir Y, Kabbaj N, Dafiri R, Imani F. Imaging of urinary Candida bezoars. Prog Urol. 1999. 9:513–517.

7. Sales JL, Mundy HB. Renal candidiasis: diagnosis and management. Can J Surg. 1973. 16:139–143.

8. Flechner SM, McAninch JW. Aspergillosis of the urinary tract: ascending route of infection and evolving patterns of disease. J Urol. 1981. 125:598–601.

9. Modi P, Goel R. Synchronous endoscopic management of bilateral kidney and ureter fungal bezoar. Urol Int. 2007. 78:374–376.

10. Smaldone MC, Cannon GM, Benoit RM. Case report: bilateral ureteral obstruction secondary to Aspergillus bezoar. J Endourol. 2006. 20:318–320.