Presentation
Right flank pain with fever and chills in a diabetic patient with a history of urinary tract infection.
Patient Data
Swollen right kidney with multiple hypoenhancing areas seen on both, arterial and portal phases, giving striated nephrogram. Thickening with increased enhancement of the renal pelvis (pyelitis). Perinephric fat stranding with thickening and enhancement of the perirenal fascias as well as mild reactive peritoneal effusion.
Mild pleural effusion (more on the right). A focal splenic infarct is noted.
Small hypodense lesion in segment 4 of the liver (ultrasound +/- MRI were requested).
Case Discussion
CT features of acute pyelonephritis.
Practical points:
CT is the most sensitive modality for diagnosis and assessment of complications
areas of reduced enhancement on the CT portal venous phase compared to the normal portions of the kidney is the key to diagnosis
striated nephrogram on CT excretory phase
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