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figure a

After IV enhancement, zones of renal infarction look like wedge-shaped low-density areas. Capsule and subcapsular kidney parenchyma is enhanced in many (but not all) patients due to collateral blood supply that forms the “cortical rim” sign (↑). This sign seldom occurs in pyelonephritis. For correct diagnosis the results must definitely correlate to clinical features.

In ischemic necrosis of the renal cortex, patients demonstrate enhancement of the medulla and capsule separated by a zone of cortical necrosis of low density forming the “reversed rim” sign (∆). Up to 50 % of such cases refer to pregnancy complications and also shock and sepsis.