Pyelonephritis other imaging findings

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Other investigations might be used to diagnose pyelonephritis. Voiding cystourethrogram (VCUG), contrast nephrograms, intravenous pyelography, and urography are helpful in diagnosing pyelonephritis and its complications.

Other Imaging Findings

Other investigations might be used to diagnose pyelonephritis.

Voiding cystourethrogram (VCUG)

A VCUG is an x ray image of the bladder and urethra taken while the bladder is full and during urination (also known as voiding). The procedure is performed in an outpatient center or hospital by an x ray technician supervised by a radiologist, who then interprets the images. Anesthesia is not needed, but sedation may be used. The bladder and urethra are filled with contrast medium to make the structures clearly visible on the radiographs. The x ray machine captures images of the contrast medium while the bladder is full and when the person urinates. This test can demonstrate abnormalities of the inside of the urethra and bladder and is usually used to detect VUR in children.[1]

Contrast Nephrograms

  • Acute pyelonephritis consists of focal areas of striated or wedge-shaped hypoperfusion, resulting in a characteristic striated nephrogram.
  • Striations result from stasis of contrast material within edematous tubules that demonstrates increasing attenuation over time.
  • The infected kidney is usually enlarged, and there is often stranding in the perinephric fat.
  • Delayed views of the infected kidney may demonstrate a nephrogram with increased attenuation.

Intravenous Pyelography

  • Intravenous pyelography (IVP) is done to diagnose an intrarenal or perinephric abscesses. IVP is a very sensitive radiological test for this purpose.[2]


  • Urography can be used to diagnose patients with acute pyelonephritis and in some cases with xanthogranulomatous pyelonephritis.[3]
  • Classic urographic triad in diffuse xanthogranulomatous pyelonephritis consists of:
    • Unilaterally decreased or (more commonly) absent renal excretion
    • A staghorn calculus
    • Poorly defined mass or diffuse renal enlargement
  • Failure to respond to antibiotic therapy or recurrence of symptoms may be taken as an indication to perform urography.


  1. Yousefichaijan P, Dorreh F, Shahsavari S, Pakniyat A (2016). "Comparing between results and complications of doing voiding cystourethrogram in the first week following urinary tract infection and in 2-6 weeks after urinary tract infection in children referring to a teaching hospital". J Renal Inj Prev. 5 (3): 144–7. doi:10.15171/jrip.2016.30. PMC 5040001. PMID 27689111.
  2. Hoverman IV, Gentry LO, Jones DW, Guerriero WG (1980). "Intrarenal abscess. Report of 14 cases". Arch Intern Med. 140 (7): 914–6. PMID 6992728.
  3. Sandberg T, Stokland E, Brolin I, Lidin-Janson G, Svanborg Edén C (1989). "Selective use of excretory urography in women with acute pyelonephritis". J Urol. 141 (6): 1290–4. PMID 2724423.

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