Acute pyelonephritis with renal vein thrombosis

Case contributed by Aakash Patel
Diagnosis certain


Patient presented with left flank pain, heaviness and fever.

Patient Data

Age: 35 years
Gender: Female

Axial and coronal nephrogenic phase CT scan shows an enlarged left kidney with a striated nephrogram and perinephric fat stranding, suggestive of acute left pyelonephritis.

A well defined filling defect noted in left renal vein near the renal hilum reaching upto the level of drainage of gonadal vein, suggestive of left renal vein thrombosis.

A longitudinally oriented calculus noted in left proximal ureter.

Case Discussion

Pyelonephritis is a bacterial infection of the renal parenchyma and renal pelvis commonly seen in young females. It is most commonly associated with ascending spread of urinary tract infection. In cases of hematogenous spread of infection, renal abscess formation is more likely. E. coli is the most commonly found organism.

Evidence of obstruction in the setting of pyelonephritis urgently requires percutaneous nephrostomy. 

Renal vein thrombosis secondary to pyelonephritis is very rare and is usually a late complication secondary to sepsis.

Emphysematous pyelonephritis is a complicated form of acute pyelonephritis, characterized by gas bubbles within the collection system.

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