Pyelonephritis echocardiography and ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Ultrasound

• In patients with recurrent ascending urinary tract infections, it may be necessary to exclude an anatomical abnormality, such as vesicoureteral reflux (urine from the bladder flowing back into the ureter) or polycystic kidney disease. Investigations that are commonly used in this setting are ultrasound of the kidneys or voiding cystourethrography.
• Emphysematous Pyelonephritis: Ultrasound will characteristically show an enlarged kidney containing high-amplitude echoes within the renal parenchyma, often with low-level posterior dirty acoustic shadowing; however, the depth of parenchymal involvement may be underestimated at ultrasound, and multiple renal stones may also manifest as echogenic foci without "clean" posterior shadowing.
• Xanthogranulomatous Pyelonephritis: At sonography, the inflammatory mass itself is hypoechoic, with central echogenic foci corresponding to renal calculi.