Imaging in upper urinary tract infections

Abstract

Most infections of the upper urinary tract are straightforward and do not require any emergency radiological investigations. A sonogram carried out within 48 hours will in most cases be sufficient to eliminate obstructed pyelonephritis requiring emergency drainage of urine. In complicated cases, or those affecting already weakened areas, an urgent CT scan is necessary, preferably after injection of iodinated contrast medium if renal function permits. CT scanning is far better at diagnosis than sonography as well as at investigating whether there are complications. Furthermore, it is essential that the radiologist is aware of unusual and rare forms of pyelonephritis, especially pseudotumoural forms, so that clinicians can be pointed towards the appropriate treatment, avoiding unnecessary and invasive interventions.

Is the mean platelet volume a predictive marker for the diagnosis of acute pyelonephritis in children?

“…In addition, this method is costly and exposes children to radioactive chemicals. Furthermore, DMSA cannot distinguish between old scarring and acute parenchymal involvement [14,15]. Thus, an easier and more practical method is necessary.…”

Long-Term Results after Acute Therapy of Obstructive Pyelonephritis

“…CT scan confirms till 97% of ureteral or renal stones and 100% of tumors [4,5,17]. The same signs of OPN than in sonography might be demonstrated with a higher sensitivity [4,10]. Pelvic wall thickening has a sensitivity of 76% for pyonephrosis.…”

“…In our group, we did not find papillary necrosis, blood clots or fungus ball, tumor obstruction of the upper urinary tract, radiation therapy, bilharziosis, or tuberculosis as further causes of endoluminal OPN or tumor compression of the upper urinary tract and M. Ormond as further causes of extrinsic OPN mentioned in the literature [10,11]. …”

“…Bacterial toxins may lead to calycopyelectasis without anatomical obstruction. Associated structures in the abdomen and pelvis can be imaged, which may reveal the cause or level of the obstruction [2,4,5,10,17]. …”

Recomendaciones prácticas para el diagnóstico y tratamiento de la infección urinaria en el adulto (I)

“…4,5,26 La TC con contraste es más sensible que la ecografía para identificar abscesos de pequeño tamaño y áreas de nefritis local. 19,26 La radiografía simple de abdomen tiene un papel limitado pero todavía está indicada en casos de sospecha de urolitiasis (dilatación del sistema pielocalicial objetivada en la ecografía sin que se detecte un cálculo) 26 o pielonefritis enfisematosa (pielonefritis grave en un paciente diabético). 19 El estudio morfológico y/o funcional de las vías urinarias (ecografía renovesical, pielografía intravenosa con placa postmiccional y/o uro-TC) puede llevarse a cabo una vez resuelto el episodio agudo.…”