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