ABSTRACTKidney disease presenting with cutaneous fistula is a rare condition. We present a case of a 90-year-old woman with dementia who had no prior urological problems and had a cutaneous fistula in the left lumbar region. A fistulogram and computer tomography examination revealed a large staghorn calculus with signs of xanthogranulomatous pyelonephritis in the left kidney and renal fistulisation to the psoas muscle, skin and bronchi. To our knowledge this is the first report in the literature of coexisting renal fistulisation to the psoas major muscle, skin and bronchi. This report illustrates how computed tomography in combination with fistulography can resolve the diagnostic dilemma that pertains to the complex spread of the disease in cases involving nephrocutaneous fistula. Furthermore, the report shows how a renal calculus, even asymptomatic, can cause a serious medical condition, and highlights the importance of early medical intervention.

The external jugular vein is increasingly being utilized as the recipient vein in head and neck free tissue transfers, and for cannulation in order to conduct diagnostic procedures or intravenous therapies. The variations in the patterns of its course, and knowledge of them, are therefore important. We report on a unique and previously non-described unilateral fenestration and duplication of the external jugular vein found during the neck dissection of a 77-year-old female cadaver. Embryological evaluation and clinical implications of the anomaly are described. Clinicians and surgeons performing neck vascular or reconstructive surgery should be aware of this variation of the external jugular vein in the hope of preventing inadvertent injury.

La vena yugular externa se está utilizando cada vez como vena receptora en la transferencias de tejidos libres de cabeza y cuello, y para canulización en procedimientos de diagnóstico o terapias intravenosas. Las variaciones en los patrones de su curso, y el conocimiento de los mismos son relevantes. Se reporta una fenestración unilateral, no descrita previamente, y la duplicación de la vena yugular externa encontrada durante la disección del cadáver de una mujer de 77 años de edad. Se hace una evaluación embriológica y las implicaciones clínicas de esta anomalía. Los médicos y cirujanos que realizan cirugía vascular o reconstructiva de cuello deben tener en cuenta esta variación de la vena yugular externa con el fin de prevenir lesiones accidentales.