Acute pyelonephritis

Case contributed by Dr Bruno Di Muzio


Patient treating urinary infection for three days. Presenting with high fever and positive Giordano sign positive bilaterally (costovertebral angle tenderness).

Patient Data

Age: 40 years
Gender: Female

CT Abdomen and pelvis

Both kidneys show focal regions with reduced enhancement compared with the normal portions of the kidney. There are minimal bilateral basal pleural effusion. Remainder exam is unremarkable. 

Case Discussion

This case represents a clinical evolution from a lower urinary tract infection which demonstrated clinical signs of pyelonephritis: high fever, flank pain (costovertebral angle tenderness + bilaterally), white cells and bacteria in the urine, and increased WCC (WBC) in the blood samples. 

The antibiotics were changed, and the patient experienced recovery in the following days. 

Usually, as it was in this case, clinical features are enough to confirm the diagnosis and no imaging studies are necessary. Ultrasound is a good option to exclude obstructive causes. 

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Case information

rID: 40264
Published: 16th Oct 2015
Last edited: 12th Aug 2020
System: Urogenital
Inclusion in quiz mode: Included

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