Pyelonephritis in pregnancy (MRI)

Case contributed by Dr Vikas Shah

Presentation

26/40 pregnant. Right-sided abdominal pain and fever and leukocytosis.

Patient Data

Age: 25 years
Gender: Female

Normal appendix. 

Thin rim of free fluid surrounding the right kidney. Signal alteration in medial portion of upper pole on gradient echo images, with some reduction in signal here. DWI and ADC images indicate restricted diffusion in this part of the right kidney. Bilateral physiologic hydronephrosis with ureteric compression between the uterus and the psoas muscles.

Case Discussion

The urine dipstick was positive for leukocytes, and the patient was treated for pyelonephritis with an uneventful recovery. The study shows the value of diffusion-weighted imaging in identifying foci of inflammation that may be more difficult to identify on other sequences. Physiologic hydronephrosis is a common finding, with smooth tapering of the dilated ureter between the gravid uterus and the psoas muscle being the key sign.

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