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Age: 25

Sex: Female

Indication: Right flank pain, pregnant patient

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Case #8


Findings

  • Multifocal areas of parenchymal hyperechogenicity and decreased corticomedullary differentiation involving the right kidney with mild right hydronephrosis
  • No perinephric collection or renal calculi
  • Normal appearance of the left kidney and urinary bladder


Diagnosis

Pyelonephritis

Sample Report

Multifocal areas of parenchymal hyperechogenicity and decreased corticomedullary differentiation involving the right kidney, concerning for pyelonephritis. No evidence of renal or perinephric abscess. Mild right hydronephrosis. No urinary tract calculi identified.


Discussion

  • Pyelonephritis is a diagnosis typically made clinically, though imaging plays an important role in assessing for complications
  • CT is typically the preferred imaging modality in patients with pyelonephritis, but ultrasound also has a role, particularly in children and pregnant women
  • Renal ultrasound is most often normal in appearance in cases of uncomplicated pyelonephritis, but may show abnormalities including:
    • Areas of parenchymal hypoechogenicity (related to edema) or hyperechogenicity (related to hemorrhage) with resulting decreased corticomedullary differentiation
    • Areas of relatively decreased renal perfusion
  • Important complications to be on the lookout for include:
    • Renal and perinephric abscesses
    • Parenchymal and collecting system gas
    • Obstructing calculi
    • Venous thrombosis


Images

Area of cortical hyperechogenicity in the interpolar right kidney with decreased corticomedullary differentiation (red arrows), concerning for pyelonephritis.

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