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Hemorrhagic focal bacterial nephritis: findings on gray-scale sonography and CT
Abstract:
Five patients with acute focal bacterial nephritis and hematuria had sonographic and CT findings atypical for renal infection. Sonographically, each presented with an echogenic focus in the renal parenchyma. Noncontrast CT images showed an area of increased density in the corresponding segment of the kidney in three patients, mixed high and low density in one patient, and low density alone in the remaining patient. It is proposed that these appearances result from the presence of hemorrhage at different stages, associated with focal infection. Venous compromise is suggested as the etiology.
Insights
Atypical imaging findings in acute focal bacterial nephritis, including echogenic foci and varied CT densities, suggest hemorrhage associated with infection. Venous compromise may be the underlying cause of these renal presentations.
Area of Science:
- Nephrology
- Radiology
- Pathology
Background:
- Acute focal bacterial nephritis (lobar nephronia) is a severe kidney infection.
- Typical imaging findings can be subtle, posing diagnostic challenges.
- Hematuria is a common symptom requiring investigation.
Purpose of the Study:
- To describe atypical sonographic and CT findings in patients with acute focal bacterial nephritis and hematuria.
- To propose a unifying hypothesis for these imaging appearances.
- To suggest a potential underlying etiology for the observed presentation.
Main Methods:
- Retrospective analysis of five patients with acute focal bacterial nephritis and hematuria.
- Review of sonographic and computed tomography (CT) imaging characteristics.
- Correlation of imaging findings with clinical presentation.
Main Results:
- Sonography revealed echogenic foci in the renal parenchyma in all patients.
- Noncontrast CT showed diverse density patterns: increased (3 patients), mixed (1 patient), and low (1 patient).
- These findings were atypical for standard presentations of renal infection.
Conclusions:
- Atypical imaging findings in acute focal bacterial nephritis may represent hemorrhage at various stages.
- Hemorrhage is proposed to be associated with the focal infection process.
- Venous compromise is suggested as a potential cause for this presentation.