January 2018

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Pyelonephritis. • Inflammation of the kidney affecting the tubules, interstitium, and renal pelvis, most commonly due
AMSER Case of the Month January 2018 29 year old female with right sided pain By Gaukhar “Grace” Amandossova Lake Erie College of Osteopathic Medicine, MS III

Dr. Matthew Hartman Medical Student Coordinator; AHN Health System

HPI and Medical History • CC/HPI: 29 yr old female presents with right sided abdominal pain (7 months duration), and one day of fever, nausea vomit, chills, body aches. • Past Medical Hx: no pertinent hx • Past Surgical Hx: C-section (7 months ago) • Past Medications: none • Social Hx: currently smokes every day (half a pack per day). Drug use: marijuana. • Vitals: BP: 132/78, HR: 97, Temp: 101.5 F (38.6 C) oral, RR: 20, SpO2: 100%, Height: 5’3, Weight: 200 lbs

Physical Exam • Abdomen: Soft. Bowel sounds normal. No mass. No tenderness, no guarding, no hernia. • Otherwise physical exam is non-contributory

What radiologic study should we order?

ACR Appropriateness criteria for Acute Abdominal Pain and Fever This imaging modality was ordered by the ER physician

https://acsearch.acr.org/docs/69467/Narrative/

CT of abdomen and pelvis with intravenous contrast Findings?

Findings: Abnormal appearance of right kidney with focal area of hypoenhancement (striated nephrogram) midpole region with some surrounding inflammation. Findings are concerning for pyelonephritis.

Pyelonephritis • Inflammation of the kidney affecting the tubules, interstitium, and renal pelvis, most commonly due to a bacterial infection, with highest incidence in young females. • In most cases clinical presentation with urinalysis is sufficient to make the diagnosis. • In our case UA was not performed prior to imaging, but later confirmed the diagnosis. • In most cases imaging is not required, and patients respond rapidly to antibiotic therapy. • In cases when imaging has been performed, there is no need for follow-up imaging, unless patients do not respond clinically, or if there is a complication such as an abscess.

References • Clinical Radiology: The Essentials. Dr. Richard H. Daffner,‎Dr. Matthew Hartman, Fourth Edition. • Robbins & Cotran Pathologic Basis of Disease. Vinay Kumar,‎Abul K. Abbas,‎Jon C. Aster. 9th Ed • Radiopedia.org • https://acsearch.acr.org/docs/69467/Narrative/