Korean J Urol.  2014 Jul;55(7):482-486. 10.4111/kju.2014.55.7.482.

Relationship Between Uncommon Computed Tomography Findings and Clinical Aspects in Patients With Acute Pyelonephritis

• Kim JS
• Lee S
• Lee KW
• Kim JM
• Kim YH
• Kim ME

• KMID: 1794578
• DOI: http://doi.org/10.4111/kju.2014.55.7.482

Abstract

PURPOSE
Computed tomography (CT) has become popular in the diagnosis of acute pyelonephritis (APN) and its related complications in adults. The aim of this study was to investigate the relationship between uncommon CT findings and clinical and laboratory data in patients with APN.
MATERIALS AND METHODS
From July 2009 to July 2012, CT findings and clinical data were collected from 125 female patients with APN. The six uncommon CT findings (excluding a wedge-shaped area of hypoperfusion in the renal parenchyma) studied were perirenal fat infiltration, ureteral wall edema, renal abscess formation, pelvic ascites, periportal edema, and renal scarring. The clinical parameters analyzed were the age and body mass index of the patients as well as the degree and duration of fever. Laboratory parameters related to inflammation and infection included white blood cell count, C-reactive protein (CRP) level, erythrocyte sedimentation rate, pyuria, and bacteriuria.
RESULTS
The most common CT finding was perirenal fat infiltration (69 cases, 55%). A longer duration of fever, higher CRP level, and grade of pyuria were related with perirenal fat infiltration (p=0.010, p=0.003, and p=0.049, respectively). The CRP level was significantly higher in patients with renal abscess and ureteral wall edema (p=0.005 and p=0.015, respectively).
CONCLUSIONS
The uncommon CT findings that were related to aggravated clinical and laboratory parameters of APN patients were perirenal fat infiltration, ureteral wall edema, and renal abscess formation. The inflammatory reaction and tissue destruction may be more aggressive in patients with these CT findings.

Keyword

Pyelonephritis; X-ray computed tomography

MeSH Terms

Abscess/etiology/radiography
Acute Disease
Adipose Tissue/pathology/radiography
Adult
Edema/etiology/radiography
Female
Humans
Kidney Diseases/radiography
Middle Aged
Pyelonephritis/complications/pathology/*radiography
Retrospective Studies
Tomography, X-Ray Computed/methods
Ureteral Diseases/etiology/radiography

Figure

• 

  FIG. 1 Computed tomography finding of periportal edema. Contrast-enhanced computed tomography scan of a 58-year-old female patient who was referred to abdominal computed tomography for evaluation of clinically suspected pyelonephritis, which was confirmed. Computed tomography revealed periportal low attenuation, indicating periportal edema.

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