Pyelonephritis slide share


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Pyelonephritis slide share

  1. 1. By: Dr Rekha Khare MD Radiology
  2. 2. Clinical Presentation…..  A 25 year young man came to the x-ray department for ultrasound exam  Complaints: - rapid onset of high fever - painful mass right flank
  3. 3. Ultrasound findings….. Enlarged right kidney with dilated pelvis with no hydrocalyx Indistinct hypoechoic inferior pole
  4. 4. U/S finding contd….. Huge heterogenous hyperechoic perinephric mass lesion all over involving inferior pole too Bulky right psoas muscle
  5. 5. CECT as further imaging Bulky right kidney with focal non enhancing hypodense area lower pole not sparing the peripheral cortical rim (renal infarction-cortical rim sign +ve)
  6. 6. CECT finding contd….. Huge multi septate hypodense soft tissue thickening mimicking mass in perinephric space having few small fluid collection involving inferior pole also
  7. 7. CECT findings contd….. Bulky right psoas muscle with some hypodense lesion? collection Mild hepatomegaly
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  25. 25. Clinical diagnosis….. Acute pyelonephritis with severe perinephric inflammation with some fat stranding no ureteric calculus 0r obstructive pathology
  26. 26. What is perinephric space? Cone shaped retroperitoneal compartment containing kidney, adrenal, fat, fibrous bridging septa & rich net work of perirenal vessel & lymphatic
  27. 27. How PNS gets involve? From outside lesion via -lymphatic -direct - in malignancy or infection From inside renal lesion -acute process, injury to the kidney,calyceal rupture in acute ureteric obstruction
  28. 28. What is perinephric stranding? It is linear areas of abnormal increased attenuation in soft tissue/ fat- resulting from: - acute renal inflammatory or infective lesion with NO HYDRONEPHROSIS - calyceal rupture in acute ureteric obstruction with HYDRONEPHROSIS
  29. 29. D/D perinephric mass lesion….. Perinephric abscess/ urinoma/ hematoma Mass/ lymphoma/ Tumour Misc.…. Proliferative disease
  30. 30. Acute pyelonephritis…..  It is an infection of renal parenchyma usually caused by an ascending infection from lower urinary tract  Most common offending pathogen E.coli  It is almost always curable with antibiotic  No lasting damage to kidney
  31. 31. Case review after a month….. Symptomatic relief Advised: repeat U/S & CECT
  32. 32. Ultrasound after a month…. Minimal residual ill defined right renal inferior pole Perinephric space appears clear
  33. 33. CECT after a month….. Minimal residual lesion at right renal lower pole Perinephric space clear
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  41. 41. Case review after3 months….. Patient fit and fine On follow up imaging-- -no residual lesion on ultrasound and plain CT scan
  42. 42. NCCT image after 3 months
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  46. 46. Role of imaging….. Imaging required to exclude- -obstructed kidney -previous renal pathology -mass lesion -high risk patient Acute pyelonephritis: clinico-pathological diagnosis
  47. 47. Follow up Imaging….. Not really essential Imaging changes can take 3-6 months to resolve complication
  48. 48. References….. 1. Acute bacterial pyelonephritis Dr Yuranga Weerakkody and Dr Frank Gaillard et al 2. Differential Diagnosis of Perinephric Masses on CT and MRI Antonio Westphalen, Benjamin Yeh, Aliya Qayyum, Anil Hari and Fergus V. Coakle American Journal Of Roentgenology,2004;183:1697-1702