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Lower UTI
Upper UTI
Complication
Role of imaging:
› Medical conditions
› Surgical conditions (pyonephrosis, renal abscess,
perinephric abscess)
Prefered exam: ultrasound
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Role : to find out the underlying pathology
Indication
Suspected of KUB stone
Uncommon infection: TB, fungus
Poor respond to antibiotics
Recurrent infection
Suspected of neurogenic bladder
Suspected of complicated UTI › Due to immunocompromised
host or underlying DM
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IVP
› May be normal
› Enlarged kidney
› Displaced calyces
› Delayed nephrogram
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US
› Enlarged kidney
› Decreased parenchymal echogenicity
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CT Scan
› Enlarged affected
kidney
› Patchy decreased
density on pre-contrast
› Perinephric fat stranding
› Decreased
enhancement
› Urothelial thickening
› Striated nephrogram
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A 19-year-old woman with acute left flank pain.
Non-contrast
Post-contrast
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Preferred exam: US or CT
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Preferred exam: US or CT
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Pus produces fluid layers
(dependent echogenic
debris) within the dilated collecting system
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Severe necrotizing infection
E. coli is frequent associated causative
organism.
Characterized by gas within renal parenchyma
and occasionally within perirenal tissues.
More than 90% of cases occur in diabetic
patients
Female predominance
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Plain film
› Air in renal parenchyma ± entend into perirenal or retroperitoneum space
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US › Acoustic shadow from air “ring down or
reverberation” artifact
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CT scan › Renal enlargement, impaired renal function,
thickening perirenal fascia
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Emphysematous cystitis in a 62-year-old diabetic man
who presented with groin pain and hematuria.
©2004 by Radiological Society of North America
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A form of chronic pyelonephritis
› Chronic obstruction plays a part in development.
› Proteus mirabilis is frequent associated causative
organism.
› DM is an associated condition in 10% of cases
Characterized by destruction and replacement of
renal parenchyma by lipid-laden macrophages.
Gross pathologic
› Massive renal enlargement, lithiasis, hydronephrosis
› Perinephric fibrosis and lobulated yellow masses
replacing renal parenchyma.
Diffuse > focal
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Plain KUB
› Renal enlargement
› Staghorn calculus
› Extrarenal extension is
suggested by indistinct
outlines of the kidney and
psoas muscle
IVP
› Decreased or absent
excretion in 85% of cases
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CT scans › Staghorn calculus with
contracted renal pelvis
› Enlarged kidney and multiple dilated calyces
› Characteristic low-attenuation (10-15 HU), peripherally enhancing rounded masses “bear’s paw sign”
› Extrarenal extension of inflammation thickening of Gerota fascia…
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Preferred exam: US
-Decreased
renal size
-Parenchymal scar
-Focal
dilatation of
the calyx opposing the
scar
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IVP
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25% associated with pulmonary TB
1. Renal parenchyma infection
2. Ureter and collecting system
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TB kidney › Irregular calyx
› Infundibular stenosis
› Calyceal dilatation
› Fibrosis / scarring
› Amputated calyx
› Calcification
moth-eaten calyx
Infundibular stenosis
Amputation of bilateral upper pole calices
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TB ureter
› Irregular fibrosis: segmental
dilatation and stenosis of ureter
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TB bladder
› Contracted bladder = small bladder capacity
› Calcifed bladder wall