Acute unilateral pyelonephritis

Case contributed by Dr Shailaja Muniraju

Presentation

Acute severe left lumbar quadrant pain, since 2 days associated with high grade fever.

Patient Data

Age: 30 years
Gender: Male
Modality: Ultrasound

1.      Bulky and hypoechoic left kidney with decreased vascularity. No evident calculus or                                hydronephrosis - acute pyelonephritis vs renal infarct.

2.      Right kidney shows normal imaging features.

Modality: CT

1.      Bulky and edematous left kidney with mild peri-renal fat stranding and multifocal nonenhancing areas – from papilla to cortex.

2.      No evident urinary tract gas, calculi or hydronephrosis.

3.      No renal vasculature thrombosis.

4.      No renal abscess / extrarenal collection. 

5.      No prostatomegaly or significant postvoid residual volume (measured on ultrasound).

        Features are suggestive of acute pyelonephritis.

Special thanks: Dr.H K Anand

Case Discussion

This is a case of acute pyelonephritis.

The major differential would be renal infarct:

- clinically acute.

- no perirenal inflammatory changes.

- usually the outer 20-24 mm would still enhance on post-contrast study (cortical rim sign), due to collateral capsular perfusion. It can be best appreciated after about 8 hours of occlusion.

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Case Information

rID: 50687
Case created: 17th Jan 2017
Last edited: 21st Jan 2017
System: Urogenital
Inclusion in quiz mode: Included

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