Presentation
Right loin pain and fever.
Patient Data
CT urography shows patchy renal parenchymal enhancement, with wedge-shaped areas of hypoenhancement, more on the right. Thick right renal pelvis wall with marked perirenal fat stranding and thick Gerota fascia. Mild free ascites.
Multiple small para-aortic lymph nodes, mostly inflammatory. Reactive gallbladder wall edema and porta hepatis lymph nodes. Reactive right lung basal pleural reaction and multiple atelectatic bands.
Case Discussion
Laboratory investigations revealed high inflammatory markers and marked pus in urine (>100 cells/HPF), in keeping with acute urinary tract infection. CT urography shows bilateral alternating wedges of high and low attenuation, called striated nephrograms, together with other signs of acute pyelonephritis.
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