Perirenal, peripelvic, and upper ureter abscesses in a nearly nonfunctioning kidney demonstrated by Tc-99m DMSA and Ga-67 renal SPECT

A 38-year-old woman reported intermittent chills, fever, and left flank pain lasting for approximately 20 days. Radiographs showed bilateral staghorn calculi in the kidneys. Tc-99m DMSA and Ga-67 renal SPECT were performed to preclude the possibility of acute pyelonephritis. Tc-99m DMSA scintigraphy showed minimal uptake of DMSA in the left kidney, whereas Ga-67 renal SPECT showed intense uptake in the left perirenal area and left upper ureter. Surgery revealed abscesses in the left perirenal, left peripelvic, and left upper ureter. The left kidney was removed, and pus culture showed Escherichia coli and Proteus sp.