Presentation
History of recurrent urinary tract infections.
Patient Data
The exam shows abnormal areas of decreased cortical uptake of radiotracer in both kidneys, most notably at the upper and lower poles.
Case Discussion
Technetium-99m DMSA scintigraphy is a method for the detection of acute pyelonephritis and renal scarring.
Three abnormal patterns can be encountered:
a single area of decreased cortical uptake
multiple unilateral or bilateral defects (as in this case)
diffuse involvement of an entire kidney
Renal scarring is usually associated with volume loss - focal or global: appearing as wedge-shaped defects or thinning/flattening of the cortex. That said, differentiating between acute pyelonephritis and cortical scars is difficult and should be done in conjunction with the clinical context. If helpful, follow-up imaging can be obtained no sooner than 6 months to assess for stability or resolution of lesions.
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