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Age: 8

Sex: Female

Indication: Right flank pain

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Case #26


Findings

  • Enlarged left kidney with diffuse loss of corticomedullary differentiation
  • Hypoechoic lesion at the junction of the upper pole and interpolar region of the left kidney measuring 2.2 x 1.9 cm with a thick, echogenic rim, posterior acoustic enhancement, and no internal Doppler flow
  • Mild fulness of the left renal pelvis with urothelial thickening
  • Mild cortical thinning in the upper pole of the right kidney with adjacent calyceal enlargement
  • Mild right hydroureteronephrosis with urothelial thickening
  • Mild circumferential mural thickening of the urinary bladder with layering echogenic material


Diagnosis

Pyelonephritis with renal abscess

Sample Report

Findings consistent with diffuse left pyelonephritis. A hypoechoic lesion at the junction of the upper pole and interpolar region of the left kidney measuring 2.2 x 1.9 cm is concerning for a renal abscess. Recommend followup ultrasound after treatment to ensure resolution of these findings and to better assess the renal parenchyma.

Mild fulness of the left renal pelvis and mild right hydroureteronephrosis with bilateral urothelial thickening in addition to bladder wall thickening, likely relating to urinary tract infection. No obstructing ureteral calculus identified.

Likely mild cortical scarring at the upper pole of the right kidney with adjacent calyceal enlargement, which may represent sequela of prior infection.


Discussion

  • When assessing cases of suspected pyelonephritis, make sure to look for complications like renal abscess, collecting system and renal parenchymal gas, and venous thrombosis
  • While small renal abscesses are often managed medically, drainage may be required if they enlarge or spread outside of the kidney, which happened in this case (see annotated images)
  • Collecting system fulness may be either a cause or an effect of urinary tract infection – make sure to rule out an obstructing mass or stone when you see it


Images

Hypoechoic lesion in the left kidney with an echogenic rim (red arrow), concerning for abscess. Due to clinical worsening, a CT was performed several days later which showed enlargement of the renal abscess (red arrow) and abscess extension into the posterior perinephric fat and musculature (yellow arrow). The patient went on to percutaneous drainage.

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