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Age: 11

Sex: Male

Indication: Urinary tract infection

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Case #44


Findings

  • Loss of the normal corticomedullary differentiation in the right kidney with an ill-defined hypoechoic region in the upper pole with peripheral, but no internal vascularity on Doppler analysis
  • No hydronephrosis
  • Absent left kidney
  • Bladder wall thickening with layering echogenic debris


Diagnosis

Pyelonephritis with possible phlegmon/abscess

Sample Report

Loss of the normal corticomedullary differentiation in the right kidney, which in the context of clinical concern for urinary tract infection raises concern for pyelonephritis. An ill-defined hypoechoic region in the upper pole with peripheral, but no internal vascularity is concerning for possible phlegmon/developing abscess. Recommend followup ultrasound following treatment to ensure resolution.

No hydronephrosis.

Absent left kidney.

Bladder wall thickening with layering echogenic debris, also likely related to urinary tract infection.


Discussion

  • Remember that pyelonephritis is usually a clinical diagnosis, so the value added from imaging lies in the assessment of complications, including:
    • Renal and perinephric abscesses
    • Parenchymal and collecting system gas
    • Obstructing calculi
    • Venous thrombosis
  • This is an equivocal case – if you see something that bothers you and cannot be clearly explained as artifact or a normal structure, then it is reasonable to bring the patient back for further imaging or to recommend followup imaging


Images

Possible area of hypoechogenicity in the upper pole of the right kidney without discernible internal vascularity (red arrows), which may represent phlegmon or developing abscess in the setting of pyelonephritis.

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