Presentation
Right loin pain and fever. WCC +++ in urine sample. Pyelonephritis?
Patient Data
Prior ultrasound was undertaken - no images.
This reported a diffusely echogenic right kidney compared to the normal left kidney.
No hydronephrosis or abscess.
Clinicians concerned of renal abscess as ongoing fever & worsening pain.
The right kidney is enlarged and diffusely altered in attenuation ( compare against the normal left kidney ).
No micro-abscess. No hydronephrosis.
No perinephric collection. Minor perinephric stranding around the lower pole.
Small volume pelvic free fluid.
Case Discussion
Thankfully most pyelonephritis is treated either on clinical and laboratory grounds or with the maximum of an ultrasound.
In this case although the ultrasound was indicative of pyelonephritis, but an insufficiently rapid response to medication, resulted in a CT being performed . The justification being to ensure a renal abscess or other source of infection was not apparent.
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