Presentation
2 days right iliac fossa pain, CRP 73. Ongoing fertility therapy, pregnancy test negative. US normal ?gallstones ?appendicitis
Patient Data
Subtle stranding around the proximal right ureter, with subtle urothelial thickening and enhancement. No ureteric calculi, or soft tissue filling defects within the ureter. No hydronephrosis or hydroureter. A small 2 mm calcific focus within right kidney, may represent a non-obstructing caliceal calculus, or possibly focus of parenchymal calcification, no other focus of calcification within the kidneys. No significant perinephric stranding. No perinephric collection. Normal enhancement of the renal parenchyma bilaterally.
Grossly normal appearances of the unprepared large and small bowel. Normal appendix.
Both ovaries measure 4.2cm in diameter.
Small trace of free pelvic fluid immediately posterior to the uterus, with normal physiological limits. Normal urinary bladder.
No size significant lymph node enlargement in the scanned volume.
Opinion:
Minor inflammatory change centered around the right proximal ureter, suggestive of upper urinary tract infection - suggest correlation with urine dipstick and urine culture.
No CT features of pyelonephritis. No ureteric calculi.
This image highlights the subtle fat stranding around the right proximal ureter, compared with the normal left side.
Case Discussion
Urine culture subsequently demonstrated significant growth of Escherichia coli. The clinical team did not initially suspect urinary tract infection.
This case highlights importance of identifying subtle stranding, comparing with a contralateral sign to assess for asymmetry can be useful, as was seen in this case.
It is important to assess for associated complications as well, in this case there were multiple important negatives.
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