Multiple renal aspergillus abscesses in an AIDS patient: contrast-enhancedhelical CT and MRI findings

Renal insufficiency or allergic reactions for X-ray contrast agents are fre quent limitations in immunocompromised hosts such as neutropenic or AIDS pa tients. Due to a better tolerance of contrast agents in MRI, this technique is well suited for investigation of parenchymal organs. We demonstrate an allergic AIDS patient who presented with fever and flank pain. At sonograph y, anechoic renal lesions were supposed to be non-complicated cysts; howeve r, on T2-weighted MRI, the center was of high signal. Dynamic contrast-enha nced MRI of the kidneys demonstrated an enhancing rim with ill-defined marg ins. The lesions were supposed to be multiple bilateral abscesses. Due to t he multiple dynamic contrast series, a delayed enhancement of renal parench yma was detectable adjacent to the lesion. This was suggested as accompanyi ng local pyelonephritis and an infectious etiology became more reliable. As pergillus fumigatus was identified by CT-guided biopsy as the underlying mi croorganism. The MR appearance of this manifestation has not been described previously.