Case contributed by Dr Kenny Sim


Left flank pain and fever. White cell count 33.3 x 10^9/L. Urine dipstick is positive for leukocytes.

Patient Data

Age: 25 years
Gender: Female

The left kidney is diffusely swollen and hypoenhancing relative to the right. Within the lower pole anteriorly, there is a 4 mm more well-defined hypodensity which is too small accurately characterize on CT. There is no hydronephrosis or hydroureter on the left. No perinephric collection on the left. Note is made of a 1 cm left para-aortic node at the level of the renal veins. There is a 1 mm calculus within an interpolar region calyx on the left and a 2 mm calculus within an interpolar region calyx on the right. These are non-obstructing.

Mottled opacification noted within the most inferior aspect of the Riedel's liver lobe. The gallbladder, pancreas, adrenal glands and spleen are unremarkable. Incidental splenunculus. The small and large bowel are within normal limits. The uterus lies in a neutral/retroverted position.

Minor left basal atelectasis. The imaged lung bases are otherwise unremarkable. No suspicious osseous lesion. Partially imaged left breast prosthesis.


Swollen hypoenhancing left kidney is in keeping with pyelonephritis given the clinical details provided. No left hydronephrosis, hydroureter or perinephric collection.

Case Discussion

Urine subsequently cultured E. coli.

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