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Age: 3

Sex: Female

Indication: Fever, abdominal pain

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Case #3


  • Right kidney is asymmetrically enlarged with wedge-shaped areas of increased cortical echogenicity
  • No hydronephrosis
  • Normal appearance of the left kidney
  • Urinary bladder is decompressed



Sample Report

Asymmetric enlargement of the right kidney with wedge-shaped areas of increased cortical echogenicity. This appearance is concerning for acute pyelonephritis. No hydronephrosis.

Normal appearance of the left kidney. Urinary bladder is decompressed.


  • Remember that on ultrasound, pyelonephritis may result in areas of parenchymal hypoechogenicity (related to edema) or hyperechogenicity (related to hemorrhage), both of which typically result in decreased corticomedullary differentiation
  • Make sure to assess for precipitating factors like obstructing calculi and complications including renal or perinephric abscess, venous thrombosis, and gas in the renal parenchyma or collecting system


Wedge-shaped areas of parenchymal hyperechogenicity in the right kidney (red arrows), concerning for pyelonephritis.

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