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
4. U/S finding contd…..
Huge heterogenous hyperechoic
perinephric mass lesion all over
involving inferior pole too
Bulky right psoas muscle
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. CECT finding contd…..
Huge multi septate hypodense
soft tissue thickening mimicking
mass in perinephric space having
few small fluid collection involving
inferior pole also
26. What is perinephric space?
Cone shaped retroperitoneal
compartment containing
kidney, adrenal, fat, fibrous
bridging septa & rich net work
of perirenal vessel & lymphatic
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. 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
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. Case review after a month…..
Symptomatic relief
Advised: repeat U/S & CECT
32. Ultrasound after a month….
Minimal residual ill defined
right renal inferior pole
Perinephric space appears
clear
33. CECT after a month…..
Minimal residual lesion at
right renal lower pole
Perinephric space clear
46. Role of imaging…..
Imaging required to exclude-
-obstructed kidney
-previous renal pathology
-mass lesion
-high risk patient
Acute pyelonephritis: clinico-pathological
diagnosis
47. Follow up Imaging…..
Not really essential
Imaging changes can take
3-6 months to resolve
complication
48. References…..
1. Acute bacterial pyelonephritis
Dr Yuranga Weerakkody and Dr Frank Gaillard et al
Radiopaedia.org
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