ĬT is the preferred imaging modality for the evaluation of complicated pyelonephritis because it provides both physiologic and anatomic detail and identifies both extrarenal and intrarenal pathology. However, new techniques such as tissue harmonics have showed sensitivity and specificity of 97% and 80%. In one study, ultrasound findings were noted in only 24% of patients, while other studies report only 20% of patients. However, ultrasound is limited in its ability to differentiate calcification from gas within the collecting system or parenchyma, visualization of small abscesses, and perinephric extension of infection which are all common in early infections. The urinary bladder may also be evaluated in this setting and can show amount of residual urine volume, presence of bladder wall thickening, or potentially a stone. There may be changes in the renal echogenic pattern and the involved kidney which can be either hyperechoic or hypoechoic. Gray-scale imaging features of pyelonephritis include renal enlargement, hydronephrosis, loss of renal sinus fat due to edema, loss of corticomedullary differentiation, areas of hypoperfusion on color Doppler, and abscess formation. US serves as a good screening modality to evaluate for structural anatomic anomalies or complications of urinary tract infection, such as hydronephrosis and obstructive uropathy. Ultrasound (US) is a readily available imaging modality to serve as the initial modality in the evaluation of patients who have the clinical diagnosis of pyelonephritis. This section highlights the imaging features of acute pyelonephritis, renal and perinephric abscess, pyonephrosis, emphysematous pyelonephritis, xanthogranulomatous pyelonephritis, and renal tuberculosis, using multimodality approach. Various imaging modalities, including ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), are useful in the diagnosis and depiction of urinary tract infections. It also helps to look for structural abnormalities of the urinary tract, which guide appropriate medical or surgical therapy. However, diagnostic imaging can play an important role in the evaluation of patient’s infections who do not respond to antibiotic treatment in the first 72 h. In general, imaging is not necessary for the diagnosis of uncomplicated urinary tract infections in adult patients. The diagnosis is usually based on clinical symptoms and urinalysis. Urinary tract infection is the most common urologic ailment, reported to affect 150 million patients annually worldwide. In this section, we discuss urologic infections such as pyelonephritis, pyonephrosis, renal abscess, pyelonephritis, emphysematous pyelonephritis, and renal tuberculosis as well as complications of infected renal stones. Potential complications can arise from chronic infection stones, such as chronic obstructive pyelonephritis, pyonephrosis, xanthogranulomatous pyelonephritis, and end-stage renal replacement lipomatosis. Struvite stones or infection stones develop in patients with recurrent urinary tract infections. MDCT also plays a vital role in the evaluation of patients with symptomatic stone disease. Ultrasound and multidetector CT are useful imaging modalities in the evaluation of patients with both acute and chronic urologic infection such as either pyelonephritis or renal abscess. Even though the diagnosis can be made based upon the patient’s clinical symptoms and the laboratory results in most cases, diagnostic imaging can play a role in the assessment of patients who don’t respond to medical therapy. Urinary tract infections are a common urologic ailment which affects 150 million people worldwide every year.
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