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Lee A, Kim HC, Hwang SI, Chin HJ, Na KY, Chae DW, Kim S. Clinical Usefulness of Unenhanced Computed Tomography in Patients with Acute Pyelonephritis. J Korean Med Sci 2018; 33:e236. [PMID: 30224907 PMCID: PMC6137028 DOI: 10.3346/jkms.2018.33.e236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/14/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Unenhanced computed tomography (UCT) may be useful for evaluating acute pyelonephritis; however, no study has compared UCT with enhanced computed tomography (ECT) as a diagnostic tool. We evaluated a clinical usefulness of UCT versus ECT in acute pyelonephritis (APN). METHODS We reviewed the clinical and radiological data from 183 APN-suspected patients who underwent UCT and ECT simultaneously at emergency room (ER) over a two-year period. Demographic, clinical parameters and computed tomography (CT) parameters of 149 patients were compared. RESULTS The average patient age was 61.2 (± 10) years: 31 patients were men. Ninety-nine (66.4%) patients showed stones (18.7%), perinephric infiltration (56%), swelling (21%), and hydronephrosis (6.7%) on UCT. Seventeen patients (11.4%) had an atypical clinical course, requiring additional tests for accurate diagnosis. In 7 patients UCT and ECT results did not differ; in 10 patients, the diagnosis changed on ECT. On ECT, 112/149 (75.2%) patients had stones (16.7%), perinephric infiltrations (57%), swelling (21%), and hydronephrosis (6.7%); 62.5% showed parenchymal involvement: 34 (22.8%) patients had no abnormal ECT findings. APN CT findings are similar on stone, perinephric infiltration, swelling and hydronephrosis on both CTs. Twelve patients (8.0%) had an abnormal ECT finding, i.e., low-grade (1 and 2) parenchymal involvement. Six (4%) patients developed contrast-induced acute kidney injury within 2 days after ECT. CONCLUSION We demonstrate that UCT is not inferior to ECT as an initial tool for evaluating APN for screening nephrolithiasis and hydronephrosis without the risk of contrast-induced acute kidney injury (CIAKI). However, patients with an atypical clinical course may still need ECT.
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Affiliation(s)
- Anna Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sung Il Hwang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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El-Merhi F, Mohamad M, Haydar A, Naffaa L, Nasr R, Deeb IAS, Hamieh N, Tayara Z, Saade C. Qualitative and quantitative radiological analysis of non-contrast CT is a strong indicator in patients with acute pyelonephritis. Am J Emerg Med 2017; 36:589-593. [PMID: 29055617 DOI: 10.1016/j.ajem.2017.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To evaluate the performance of non-contrast computed tomography (CT) by reporting the difference in attenuation between normal and inflamed renal parenchyma in patients clinically diagnosed with acute pyelonephritis (APN). MATERIAL AND METHODS This is a retrospective study concerned with non-contrast CT evaluation of 74 patients, admitted with a clinical diagnosis of APN and failed to respond to 48h antibiotics treatment. Mean attenuation values in Hounsfield units (HU) were measured in the upper, middle and lower segments of the inflamed and the normal kidney of the same patient. Independent t-test was performed for statistical analysis. Image evaluation included receiver operating characteristic (ROC), visual grading characteristic (VGC) and kappa analyses. RESULTS The mean attenuation in the upper, middle and lower segments of the inflamed renal cortex was 32%, 25%, and 29% lower than the mean attenuation of the corresponding cortical segments of the contralateral normal kidney, respectively (p<0.01). The mean attenuation in the upper, middle, and lower segments of the inflamed renal medulla was 48%, 21%, and 30%, lower than the mean attenuation of the corresponding medullary segments of the contralateral normal kidney (p<0.02). The mean attenuation between the inflamed and non-inflamed renal cortex and medulla was 29% and 30% lower respectively (p<0.001). The AUCROC (p<0.001) analysis demonstrated significantly higher scores for pathology detection, irrespective of image quality, compared to clinical and laboratory results with an increased inter-reader agreement from poor to substantial. CONCLUSION Non-contrast CT showed a significant decrease in the parenchymal density of the kidney affected with APN in comparison to the contralateral normal kidney of the same patient. This can be incorporated in the diagnostic criteria of APN in NCCT in the emergency setting.
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Affiliation(s)
- Fadi El-Merhi
- Department of Radiology, American University of Beirut, Lebanon Riad El Solh, Beirut 1107 2020 Beirut, Lebanon.
| | - May Mohamad
- Department of Radiology, American University of Beirut, Lebanon Riad El Solh, Beirut 1107 2020 Beirut, Lebanon.
| | - Ali Haydar
- Department of Radiology, American University of Beirut, Lebanon Riad El Solh, Beirut 1107 2020 Beirut, Lebanon.
| | - Lena Naffaa
- Department of Radiology, American University of Beirut, Lebanon Riad El Solh, Beirut 1107 2020 Beirut, Lebanon.
| | - Rami Nasr
- Department of Surgery, American University of Beirut, Lebanon Riad El Solh, Beirut 1107 2020 Beirut, Lebanon.
| | - Ibrahim Al-Sheikh Deeb
- Department of Radiology, American University of Beirut, Lebanon Riad El Solh, Beirut 1107 2020 Beirut, Lebanon.
| | - Nadine Hamieh
- Department of Radiology, American University of Beirut, Lebanon Riad El Solh, Beirut 1107 2020 Beirut, Lebanon.
| | - Ziad Tayara
- Department of Radiology, American University of Beirut, Lebanon Riad El Solh, Beirut 1107 2020 Beirut, Lebanon.
| | - Charbel Saade
- Department of Radiology, American University of Beirut, Lebanon Riad El Solh, Beirut 1107 2020 Beirut, Lebanon.
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Das CJ, Ahmad Z, Sharma S, Gupta AK. Multimodality imaging of renal inflammatory lesions. World J Radiol 2014; 6:865-873. [PMID: 25431641 PMCID: PMC4241493 DOI: 10.4329/wjr.v6.i11.865] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 04/30/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Spectrum of acute renal infections includes acute pyelonephritis, renal and perirenal abscesses, pyonephrosis, emphysematous pyelonephritis and emphysematous cystitis. The chronic renal infections that we routinely encounter encompass chronic pyelonephritis, xanthogranulomatous pyelonephritis, and eosinophilic cystitis. Patients with diabetes, malignancy and leukaemia are frequently immunocompromised and more prone to fungal infections viz. angioinvasive aspergillus, candida and mucor. Tuberculosis and parasitic infestation of the kidney is common in tropical countries. Imaging is not routinely indicated in uncomplicated renal infections as clinical findings and laboratory data are generally sufficient for making a diagnosis. However, imaging plays a crucial role under specific situations like immunocompromised patients, treatment non-responders, equivocal clinical diagnosis, congenital anomaly evaluation, transplant imaging and for evaluating extent of disease. We aim to review in this article the varied imaging spectrum of renal inflammatory lesions.
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Kim JS, Lee S, Lee KW, Kim JM, Kim YH, Kim ME. Relationship between uncommon computed tomography findings and clinical aspects in patients with acute pyelonephritis. Korean J Urol 2014; 55:482-6. [PMID: 25045448 PMCID: PMC4101119 DOI: 10.4111/kju.2014.55.7.482] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/17/2014] [Indexed: 11/21/2022] Open
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.
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Affiliation(s)
- Jang Sik Kim
- Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Sangwook Lee
- Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Kwang Woo Lee
- Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jun Mo Kim
- Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Young Ho Kim
- Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Min Eui Kim
- Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea
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Sakata Y, Kinoshita N, Kato H, Yamada Y, Sugimura Y. Coexistence of renal replacement lipomatosis with xanthogranulomatous pyelonephritis. Int J Urol 2004; 11:44-6. [PMID: 14678184 DOI: 10.1111/j.1442-2042.2004.00728.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report on a case of coexistence of replacement lipomatosis with xanthogranulomatous pyelonephritis (XGP) in the same kidney associated with staghorn calculi. A 63-year-old man was admitted to hospital complaining of a right abdominal mass. Computed tomography (CT) showed renal parenchymal atrophy with extremely increased perirenal fat. Right nephrectomy was performed. Postoperative diagnosis was renal replacement lipomatosis with XGP. Renal replacement lipomatosis and XGP have several similarities in terms of clinical background and CT findings. Sometimes it is difficult to differentiate them from malignant diseases. It is extremely rare that both conditions coexist in the same kidney. To our knowledge, only one such case has been reported.
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Affiliation(s)
- Yuko Sakata
- Department of Urology, Takeuchi Hospital and Mie University School of Medicine, Tsu-city, Mie, Japan.
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Affiliation(s)
- A Kawashima
- Department of Radiology, The University of Texas-Houston Medical School, 77026, USA.
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Baumgarten DA, Baumgartner BR. Imaging and radiologic management of upper urinary tract infections. Urol Clin North Am 1997; 24:545-69. [PMID: 9275978 DOI: 10.1016/s0094-0143(05)70401-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Most infections of the upper urinary tract respond promptly to antibiotic therapy and imaging is not necessary. Patients with urinary obstruction, diabetes, or immunocompromise are more likely to develop complicated infection, abscess, or have unusual organisms. Chronic granulomatous processes involving the kidney are usually related to recurrent bacterial infections. Again, stone disease or obstruction is often an underlying problem. In those patients who do not respond promptly to treatment or have a more complicated clinical picture, imaging can assess the severity and extent of disease. CT scan is the study of choice for diagnostic evaluation in these patients and directs percutaneous intervention when appropriate. Placement of drainage catheters is often curative but also may allow the patient to stabilize until surgical treatment is accomplished. One exception is the diagnosis of pyonephrosis, which may be accomplished more easily by ultrasound. In these cases, PCN placement is generally needed and is performed under fluoroscopic guidance. Ultimately, however, definitive surgical intervention often is needed to relieve the underlying obstruction.
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Affiliation(s)
- D A Baumgarten
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Rabushka LS, Fishman EK, Goldman SM. Pictorial review: computed tomography of renal inflammatory disease. Urology 1994; 44:473-80. [PMID: 7941187 DOI: 10.1016/s0090-4295(94)80042-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- L S Rabushka
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Affiliation(s)
- A F Morey
- Department of Surgery (Urology Service), Tripler Army Medical Center, Honolulu, Hawaii 96859-5000
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Baumgartner BR, Alagappian R. Malakoplakia of the ureter and bladder. UROLOGIC RADIOLOGY 1990; 12:157-9. [PMID: 2281580 DOI: 10.1007/bf02923997] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Malakoplakia is an uncommon granulomatous inflammatory disease that most often involves the urinary tract. Typically, there is an associated urinary tract infection (UTI) by coliform organisms. Histologically, the Michaelis-Gutmann bodies are the hallmark of this disease. Radiographically, malakoplakia may simulate other inflammatory processes or even neoplasm as demonstrated in these two cases.
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Affiliation(s)
- B R Baumgartner
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia 30322
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Khanna S, Malik N, Khandelwal N. Renal candidiasis: a case report showing the contribution of computed tomography. Eur J Radiol 1990; 11:91-2. [PMID: 2253644 DOI: 10.1016/0720-048x(90)90154-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- S Khanna
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research Chandigarh, India
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