Which CT scan findings indicate complications of acute pyelonephritis?

Updated: Jul 01, 2021
  • Author: Tibor Fulop, MD, PhD, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Abscesses typically appear on CT scans as low-density masses with contrast enhancement of the wall from inflamed/dilated blood vessels (see the image below). Acute focal bacterial nephritis has a lobar distribution of inflammation, wedge-shaped hypodense lesions (postcontrast), and masslike hypodense lesions in severe infections. Xanthogranulomatous pyelonephritis (see the images below, as well as Xanthogranulomatous Pyelonephritis Imaging) may have the following CT features:

  • Large kidney calculi
  • Nonfunctioning kidneys
  • Contrast enhancement around low-attenuation areas
  • Thickening of the Gerota fascia
  • Spherical areas of low attenuation
Multiple abscesses, upper pole of left kidney. Multiple abscesses, upper pole of left kidney.

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