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Pain Imaging pp 303-322 | Cite as

Imaging of Pyelonephritis

  • Raymond OyenEmail author
Chapter

Abstract

Upper urinary tract infections are a frequent cause of abdominal pain and consequently of a medical visit in general and emergency practice. Most uncomplicated cases can be diagnosed with clinical and laboratory findings. Diagnostic imaging is required in more complicated cases to guide medical or surgical therapy. The indications for imaging in renal infection are described, and benefits and limitations of different imaging modalities. Some disease entities are more extensively described in a pictorial review.

Keywords

Diagnostic imaging Pyelonephritis Upper urinary tract infection Renal pain Renal abscess 

Supplementary material

Video 16.1

Female, 76 years. Acute abdominal pain, nausea and vomiting, chills. Coronal reformatted CT in the portal venous phase showing multisegmental infarction in the right kidney, predominantly in the lower pole of the kidney. In some case, it can be challenging to differentiate multifocal acute pyelonephritis and multifocal infarction. Correlation with the clinical symptoms and laboratory results contribute to the diagnosis. (AVI 77572 kb)

Video 16.2a

Female, 43 years. Epigastric pain, nausea, dyspnea. Coronal reformatted CT in arterial (a). Stone in the left renal pelvis and gas bubbles in the renal pelvis and smaller bubbles spread in some calyces and striated nephrogram in the upper pole. Acute emphysematous pyelonephritis. Patient was treated with a percutaneous nephrostomy and ESWL. (AVI 56068 kb)

Video 16.2b

Female, 43 years. Epigastric pain, nausea, dyspnea. Coronal reformatted CT in portal venous phase (b). Stone in the left renal pelvis and gas bubbles in the renal pelvis and smaller bubbles spread in some calyces and striated nephrogram in the upper pole. Acute emphysematous pyelonephritis. Patient was treated with a percutaneous nephrostomy and ESWL. (AVI 56068 kb)

Video 16.3a

Female, 35 years. Vaginal delivery 5 days earlier. Fever (39°); positive haemoculture. Anaemia. Severe pelvic pain. Coronal reformatted CT in arterial (a). Acute pyelonephritis of the left kidney with small areas of liquefaction extending to the renal capsule and adjacent perirenal space, not to be considered as frank abscesses. (AVI 74500 kb)

Video 16.3b

Female, 35 years. Vaginal delivery 5 days earlier. Fever (39°); positive haemoculture. Anaemia. Severe pelvic pain. Coronal reformatted CT in excretory phase (b). Acute pyelonephritis of the left kidney with small areas of liquefaction extending to the renal capsule and adjacent perirenal space, not to be considered as frank abscesses. (AVI 75268 kb)

Video 16.4a

Female 67 years. Calculus in the pelvic segment of the left ureter and clinical symptoms of pyelonephritis. MRI (coronal and axial T2-weighted images, diffusion weighted images and T1FS-weighted images) showing severe pyelonephritis of the left kidney with several parenchymal abscess locations extending into the perirenal space (complicated pyelonephritis). (AVI 38403 kb)

Video 16.4b

Female 67 years. Calculus in the pelvic segment of the left ureter and clinical symptoms of pyelonephritis. MRI (coronal and axial T2-weighted images, diffusion weighted images and T1FS-weighted images) showing severe pyelonephritis of the left kidney with several parenchymal abscess locations extending into the perirenal space (complicated pyelonephritis). (AVI 19971 kb)

Video 16.4c

Female 67 years. Calculus in the pelvic segment of the left ureter and clinical symptoms of pyelonephritis. MRI (coronal and axial T2-weighted images, diffusion weighted images and T1FS-weighted images) showing severe pyelonephritis of the left kidney with several parenchymal abscess locations extending into the perirenal space (complicated pyelonephritis). (AVI 20739 kb)

Video 16.4d

Female 67 years. Calculus in the pelvic segment of the left ureter and clinical symptoms of pyelonephritis. MRI (coronal and axial T2-weighted images, diffusion weighted images and T1FS-weighted images) showing severe pyelonephritis of the left kidney with several parenchymal abscess locations extending into the perirenal space (complicated pyelonephritis). (AVI 38403 kb)

Video 16.4e

Female 67 years. Calculus in the pelvic segment of the left ureter and clinical symptoms of pyelonephritis. MRI (coronal and axial T2-weighted images, diffusion weighted images and T1FS-weighted images) showing severe pyelonephritis of the left kidney with several parenchymal abscess locations extending into the perirenal space (complicated pyelonephritis). (AVI 30723 kb)

Video 16.5a

Boy, 8 years. Axial (a) in the late venous phase showing residual focal hypoperfusion in the midpole of the left kidney 6 weeks after ultrasound guided percutaneous aspiration of an abscess in the left kidney with aspiration of 3 ml of pus. Note the slight dilation of the renal pelvis and the hypervascular thickening of the wall of the renal pelvis. (AVI 89861 kb)

Video 16.5b

Boy, 8 years. Coronal reformatted CT (b) in the late venous phase showing residual focal hypoperfusion in the midpole of the left kidney 6 weeks after ultrasound guided percutaneous aspiration of an abscess in the left kidney with aspiration of 3 ml of pus. Note the slight dilation of the renal pelvis and the hypervascular thickening of the wall of the renal pelvis. (AVI 89861 kb)

Video 16.6

Male, 60 years. MR (axial T2-weighted, axial T1FS-weighted, coronal T2-weighted, coronal and axial turbo-flash, opposed phase, axial and coronal T1-weighted, contrast-enhanced axial images, and diffusion weighted images) showing an abscess in the upper pole of the right kidney in an almost asymptomatic patient. Because of suspicion of (abscedated) tumor, a partial nephrectomy was performed, confirming a renal abscess. Patient developed a large perirenal abscess in the postoperative period, for which an ultrasound guided percutaneous drainage was performed. (AVI 844060 kb)

Video 16.7

Female, 73 years. Hormonal therapy for metastasized breast carcinoma. Coronal reformatted CT in the portal venous phase. Xanthogranulomatous and emphysematous pyelonephritis of the right kidney with fistulisation at the midpole to a subcutaneous abscess in the right flank. (AVI 73732 kb)

Video 16.8a

Female, 58 years. Recent cystectomy and continent pouch. Sepsis. Coronal reformatted CT, portal venous phase and excretory phase. Delayed and somewhat heterogeneous nephrogram of the left kidney compared to the right kidney. This is more pronounced on the excretory phase with striated nephrogram and some more rounded areas of hypoperfusion. There are some smaller similar areas in the midpole of the right kidney. Note the heterogeneous opacification and filling of the left renal pelvis. Dilatation of the collecting system and ureters upto the level of the anastomosis with the pouch. Bilateral, multifocal acute pyelonephritis, successfully treated with appropriate antibiotics. (AVI 56068 kb)

Video 16.8b

Female, 58 years. Recent cystectomy and continent pouch. Sepsis. Coronal reformatted CT, portal venous phase and excretory phase. Delayed and somewhat heterogeneous nephrogram of the left kidney compared to the right kidney. This is more pronounced on the excretory phase with striated nephrogram and some more rounded areas of hypoperfusion. There are some smaller similar areas in the midpole of the right kidney. Note the heterogeneous opacification and filling of the left renal pelvis. Dilatation of the collecting system and ureters upto the level of the anastomosis with the pouch. Bilateral, multifocal acute pyelonephritis, successfully treated with appropriate antibiotics. (AVI 55300 kb)

Video 16.9a

Same female patient as in Video 16.8, 9 years later, now 67 years old. Bilateral ureteral reimplantation 5 years before. Now clinical symptoms of right sided pyelonephritis. Coronal reformatted CT in the portal venous phase (a). No CT-features of acute pyelonephritis. Note the wide anastomose of the right reimplanted ureter in the pouch and the normal dimensions of the left ureter and anastomosis. Note the rather pronounced left renal atrophy due to chronic obstruction and inflammation. (AVI 77572 kb)

Video 16.9b

Same female patient as in Video 16.8, 9 years later, now 67 years old. Bilateral ureteral reimplantation 5 years before. Now clinical symptoms of right sided pyelonephritis. Coronal reformatted CT in the excretory phase (b). No CT-features of acute pyelonephritis. Note the wide anastomose of the right reimplanted ureter in the pouch and the normal dimensions of the left ureter and anastomosis. Note the rather pronounced left renal atrophy due to chronic obstruction and inflammation. (AVI 77572 kb)

Video 16.9c

Same female patient as in Video 16.8, 9 years later, now 67 years old. Bilateral ureteral reimplantation 5 years before. Now clinical symptoms of right sided pyelonephritis. Coronal reformatted CT in the excretory phase (c). No CT-features of acute pyelonephritis. Note the wide anastomose of the right reimplanted ureter in the pouch and the normal dimensions of the left ureter and anastomosis. Note the rather pronounced left renal atrophy due to chronic obstruction and inflammation. (AVI 77572 kb)

Video 16.10

Female patient, 71 years. Coronal reformatted CT in the portal venous phase. Staghorn calculus in the right renal pelvis and chronic inflammation with extensive replacement lipomatosis, i.e. xanthogranulomatous pyelonephritis. Note the thick walled dilated ‘calyces’, which in fact chronic inflamed and abscedated calyces and renal parenchyma. (AVI 60676 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of RadiologyCatholic University of LeuvenLeuvenBelgium

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