Post mortem computed tomography is highly sensitive for pyelonephritis. A radiologic-pathologic correlation series.

Area of Science:

• Forensic Pathology
• Radiology
• Nephrology

Background:

• Pyelonephritis is a severe kidney infection that can be fatal.
• Post mortem computed tomography (PMCT) is a valuable tool for forensic pathologists.
• The diagnostic accuracy of PMCT for pyelonephritis in forensic cases is not well-established.

Purpose of the Study:

• To evaluate the sensitivity and specificity of PMCT findings for diagnosing pyelonephritis in a forensic setting.
• To identify key radiologic signs of pyelonephritis on PMCT.
• To compare PMCT findings with autopsy and histopathology results.

Main Methods:

• Retrospective review of 16 fatal pyelonephritis cases and 16 controls at the Ontario Forensic Pathology Service.
• Analysis of radiologic (PMCT), clinical, and pathological findings.
• Autopsy and histopathology served as the gold standard for diagnosis.

Main Results:

• PMCT signs of pyelonephritis included asymmetric renal enlargement, perinephric fat stranding, and renal air.
• Perinephric fat stranding was the most sensitive individual sign (57%).
• Sensitivity reached 100% when any of the three signs were present.
• Specificities were 81% for air asymmetry, 81% for asymmetric renal enlargement, and 69% for fat stranding.

Conclusions:

• PMCT findings can suggest a diagnosis of pyelonephritis in forensic investigations.
• The presence of any of the identified PMCT signs warrants further gross and microscopic examination of the kidneys.
• PMCT can aid in screening for pyelonephritis prior to traditional autopsy.