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Computed tomographic diagnosis of unsuspected pyelonephritis in children
Katherine E Maturen1, Caroline E Blane, Peter J Strouse
1Strouse-University of Michigan Medical School, Ann Arbor, Mich., USA.
Insights
Computed tomography (CT) aids in diagnosing pyelonephritis in children with complex conditions when symptoms are unclear. This imaging technique helps identify unsuspected kidney infections, enabling prompt treatment.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Infectious Diseases
Background:
- Pyelonephritis in children often presents with fever but can have atypical symptoms.
- Classic pyelonephritis is typically a clinical diagnosis, often not requiring imaging.
- Complex comorbidities can obscure the typical presentation of pediatric pyelonephritis.
Purpose of the Study:
- To highlight the diagnostic value of computed tomography (CT) for pyelonephritis in pediatric patients.
- To demonstrate CT's utility in cases with complex comorbidities and atypical presentations.
- To emphasize CT's role when pyelonephritis is not initially suspected.
Main Methods:
- Retrospective review of CT scans and medical records for 12 pediatric patients.
- Patients diagnosed with pyelonephritis via CT, despite not having classic symptoms.
- Inclusion criteria: fever at presentation, negative or pending urine cultures in some cases.
Main Results:
- All 12 patients showed characteristic CT findings: wedge-shaped hypoattenuation (7 bilateral).
- Kidney enlargement was observed in 10 patients; perinephric fat stranding in 5.
- Focal abscesses were identified in 3 patients.
Conclusions:
- CT can diagnose unsuspected pyelonephritis in children with atypical presentations and comorbidities.
- CT allows for simultaneous evaluation of fever sources, including pyelonephritis.
- Early CT diagnosis facilitates timely initiation of therapy, even before positive urine cultures.
Objective:
To emphasize the utility of computed tomography (CT) in the diagnosis of pyelonephritis in children with complex comorbidities.
Methods:
We retrospectively reviewed the CT imaging studies and medical records of 12 patients (8 girls, 4 boys; aged 2-18 years [mean 8.6 yr]) who did not have a classic presentation of pyelonephritis but were diagnosed by CT. All patients had fever at clinical presentation, and pyelonephritis was not suspected in any case. Two children had negative urine cultures before imaging.
Results:
All 12 patients had wedge-shaped areas of hypoattenuation on CT, 7 bilaterally; 10 had enlargement of an involved kidney; 5 had perinephric fat stranding; and 3 had focal abscesses.
Conclusions:
Although classic and uncomplicated pyelonephritis is a clinical diagnosis that does not require imaging, sometimes the presentation may be equivocal and the diagnosis unsuspected. Pyelonephritis is one of several potential sources of fever that can be simultaneously evaluated using CT. Using. CT, the unsuspected diagnosis of pyelonephritis can be made and therapy initiated before the urine culture is positive.