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CT imaging of acute and chronic pyelonephritis: a practical guide for emergency radiologists

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Abstract

Contrast-enhanced CT is not routinely indicated in uncomplicated urinary infections, but it may be necessary in patients with specific risk factors (i.e., diabetes, immunocompromised patients, history of stones, or prior renal surgery) or in patients not responding to antibiotics and in detecting complications of pyelonephritis. CT is the gold standard for imaging assessment of pyelonephritis severity. Imaging appearance of acute pyelonephritis, including focal (i.e., wedge-shaped zones of decreased attenuation or hypodense mass) and diffuse (i.e., global enlargement, poor parenchymal enhancement, lack of excretion of contrast, fat stranding) forms, needs to be differentiated from renal infarction, renal lymphoma, and interstitial nephritis. Chronic pyelonephritis—which appears as focal polar scars with underlying calyceal distortion, global atrophy, and hypertrophy of residual tissue—may mimic at imaging lobar infarcts. This pictorial essay reviews the CT imaging appearance of acute and chronic pyelonephritis, their uncommon subtypes, and their complications, with key features for early diagnosis. Their knowledge is crucial for emergency and abdominal radiologists to avoid misdiagnosis with malignancy and to guide the clinician towards the appropriate medical or surgical treatment.

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Authors and Affiliations

  1. Dipartimento Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza G. D’Alessandro, University of Palermo, Palermo, Italy

    Federica Vernuccio

  2. I.R.C.C.S. Centro Neurolesi Bonino Pulejo, Contrada Casazza, SS113, 98124, Messina, Italy

    Federica Vernuccio

  3. Hôpitaux Universitaires Beaujon, Radiology, Université Paris VII, Clichy, France

    Federica Vernuccio

  4. Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BIND), University Hospital “Paolo Giaccone”, Via del Vespro, 129, 90127, Palermo, Italy

    Federica Vernuccio, Diana Patti, Roberto Cannella, Giuseppe Salvaggio & Massimo Midiri

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  1. Federica Vernuccio
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  2. Diana Patti
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Correspondence to Federica Vernuccio.

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Vernuccio, F., Patti, D., Cannella, R. et al. CT imaging of acute and chronic pyelonephritis: a practical guide for emergency radiologists. Emerg Radiol 27, 561–567 (2020). https://doi.org/10.1007/s10140-020-01788-z

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  • DOI: https://doi.org/10.1007/s10140-020-01788-z

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