Pyonephrosis CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Harsh Vardhan Chawla, M.B.B.S.[2]

CT scan

CT scan provides anatomic details and helps in distinguishing intrarenal and extrarenal pathologies.

It is difficult to distinguish hydronephrosis from pyonephrosis on a CT scan.

• The indirect signs of pyonephrosis on CT scan include:
• Enlarged kidneys
• Presence of an infected collecting system in the setting of hydronephrosis.
• Perinephric fat stranding
• Striated nephrogram
• Pelvic wall thickening
• Fluid-fluid levels and gas within the collecting system can sometimes be seen
• Other conditions like neoplasms, nephrolithiasis, congenital anomalies causing obstruction.
• A few studies have shown Hounsfield Unit (HU) levels were higher in patients with pyonephrosis as compared to hydronephrosis which can help distinguish the two conditions. HU was found to be even higher in patients with sepsis.