Renal rule 20 : Pyelonephritis

Imaging is rarely required for diagnosis, but may be helpful if a more complicated infection, such as a renal abscess, is suspected. CT findings include renal enlargement with wedge-shaped heterogeneous areas of poor enhancement, known as a     striated nephrogram

 

Contrast enhanced CT scan in patient with fever and flank pain shows ill defined linear enhancement abnormality in the left mid pole anteriorly (arrows) known as "striated nephrogram" which is a finding seen in acute pyelonephritis. Importantly, no complications of pyelonephritis are noted (e.g., no renal abscess).

 

Gray scale ultrasound image in a similar patient as the CT scan above. Notice the focal area of increased echogenicity (brightness) in the right upper pole cortex (arrows). This is a non specific finding but in a patient with symptoms of UTI, this finding is consistent with focal pyelonephritis.