Purpose
OBJECTIVES: Acute pyelonephritis is considered complicated when there is no clinical response after 72 hours of antibiotic treatment. It is related to the presence of focal nephritis , abscess and obstruction of the urinary tract. The effectiveness of CEUS in the evaluation of patients with acute pyelonephritis (APN) has already been proved. But, to date, the findings of APN in Contrast Enhanced Ultrasound (CEUS) have not been described in detail. The aims of this study are the following: To describe the different features of APN...
Methods and Materials
PATIENTS The study comprised 25 patients: 24 women and 1 man, with a mean age of 27 years ( range 14-49), during a 1 year period. The patients included (inclusion criteria) in this study were those suspects of acute complicated pyelonephritis (n=23) : those patients with APN who did not respond to intravenous antibiotic therapy within 72 hours. Other two patients suspects of acute cholecystitis which turned out to be acute complicated pielonephritis were included too. None of the patients had previous or concomitant significant...
Results
1. BASAL SONOGRAPHY. (Fig.3) (Fig.4) -Normal: 7 patients. -Enlarged heterogeneous kidney with or without perirenal fluid: 5 patients -Focal cortical lesion: Hiperechoic 11, hypoechoic 2. The pathologic changes described in the literature in APN include the presence of inflammatory cells in the interstitium,( with numerous interfaces, which explain the more frequent appearance of the lesions as hyperechoic), as well as edema and intense vasoconstriction. -Urinary tract obstruction : 2 -Extrarenal findings: Ascites (n=1), perivesicular fluid (n=1), pleural effusion (n=1). No significant pararenal collections were found....
Conclusion
The limitations of this study are the following: The series is small. Studies with larger series and statistic analisys of the data are needed . Follow up was not done in all of the patients The numbers refer to patients and not to lesions. (In six patients there were multiple lesions ) Nevertheless, the authors conclude that: CEUS clearly improves the performance of basal sonography because it detects lesions not detected by gray scale sonography. CEUS is able to distinguish focal pyelonephritis from abscess, this...
