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