Acute pyelonephritis (dual energy CT)

Case contributed by Mariam Razkala
Diagnosis almost certain

Presentation

Right flank pain for the last four days. She had a fever of 38 degrees and anorexia.

Patient Data

Age: 20 years
Gender: Female

CT technique: 

Single-phase quad-bolus IV contrast-enhanced polychromatic spectral CT.

Dual energy CT

ct

There are two large wedge-shaped areas of hypoperfusion involving the right kidney, in conjunction with infective symptoms favored to represent changes of acute pyelonephritis.

  • there are two large wedge-shaped hypodense areas involving the right kidney, in conjunction with infective symptoms favored to represent changes of acute pyelonephritis
  • normal liver, adrenals, spleen, pancreas, small bowel, large bowel, omentum, and mesentery
  • the gallbladder shows no stones, CBD is of normal caliber, and portal vein is also of normal caliber
  • no free fluid, free gas, or hernia
  • no enlarged lymph nodes
  • no acute vasculopathy

Case Discussion

Dual-energy CT can improve the diagnosis of inflamed kidney foci in acute pyelonephritis in comparison to conventional imaging 1.  Dual-energy CT allows for the identification of pathologic foci of inflamed kidney parenchyma, which is beneficial in the evaluation of acute pyelonephritis 1.

Case also courtesy of Dr. Zane Sherif

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