Renal sepsis

Acute pyelonephritis is a clinical diagnosis and, if uncomplicated, imaging is not required except to disclose an underlying cause such as calculus disease, for which an ultrasound scan or plain radiography will suffice. Acute focal pyelonephritis may progress to abscess formation or, particularly with diabetes, to emphysematous pyelonephritis, which can be detected by ultrasound ( Leyine.1994). Intravenous urography is not usually helpful, as it is much less specific than ultrasound. If the patient is not responding to antibiotic therapy, minor changes of focal pyelonephritis are best detected by CT scanning.

Ultrasound of a small thick-walled renal abscess. This abscess had a fluid (echo-free) center, which proved to be frankly purulent on ultrasound-guided needle aspiration. In its early stages an abscess may have an apparently solid center, because of solid or semisolid purulent debris, and may be indistinguishable from other renal masses such as tumor.

Streak-like zones of low attenuation in the right renal parenchyma as seen with focal acute pyelonephritis. This is best appreciated with contrast-enhanced CT. On sonography, uncomplicated pyelonephritis may be seen as areas of low attenuation. This scan follows the normal layout of cross-sectional images, and the left kidney is on the right side of each scan.

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