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Lower UTI
Upper UTI
Complication
Role of imaging:
› Medical conditions
› Surgical conditions (pyonephrosis, renal abscess,
perinephric abscess)
Prefered exam: ultrasound
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
IVP
› May be normal
› Enlarged kidney
› Displaced calyces
› Delayed nephrogram
US
› Enlarged kidney
› Decreased parenchymal echogenicity
CT Scan
› Enlarged affected
kidney
› Patchy decreased
density on pre-contrast
› Perinephric fat stranding
› Decreased
enhancement
› Urothelial thickening
› Striated nephrogram
A 19-year-old woman with acute left flank pain.
Non-contrast
Post-contrast
Preferred exam: US or CT
Preferred exam: US or CT
Pus produces fluid layers
(dependent echogenic
debris) within the dilated collecting system
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
Plain film
› Air in renal parenchyma ± entend into perirenal or retroperitoneum space
US › Acoustic shadow from air “ring down or
reverberation” artifact
CT scan › Renal enlargement, impaired renal function,
thickening perirenal fascia
Emphysematous cystitis in a 62-year-old diabetic man
who presented with groin pain and hematuria.
©2004 by Radiological Society of North America
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
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
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…
Preferred exam: US
-Decreased
renal size
-Parenchymal scar
-Focal
dilatation of
the calyx opposing the
scar
IVP
25% associated with pulmonary TB
1. Renal parenchyma infection
2. Ureter and collecting system
TB kidney › Irregular calyx
› Infundibular stenosis
› Calyceal dilatation
› Fibrosis / scarring
› Amputated calyx
› Calcification
moth-eaten calyx
Infundibular stenosis
Amputation of bilateral upper pole calices
TB ureter
› Irregular fibrosis: segmental
dilatation and stenosis of ureter
TB bladder
› Contracted bladder = small bladder capacity
› Calcifed bladder wall
