Motta RGA, Bustamante RFM, Moreno AJ, Alonso BÉ, González ML

Language: Spanish
References: 20
Page: 209-218
PDF size: 490.42 Kb.

ABSTRACT

Objective: show that acute kidney inflammation and its extrarenal manifestations, confirmed by means of multisection, multidetector and multiphasic computed tomography (CT) predispose suspicion of acute intra-abdominal inflammatory processes, which in turn causes confusion and delay in clinical diagnosis.
Material and methods: CT studies which identified the morphological syndromatic complex of findings that accompany acute kidney inflammation, including its extrarenal manifestations, which were identified as causal agent, incidental finding, and/or suspected of various specific intra-abdominal inflammatory processes, were reviewed. The studies were performed with multidetector, multisection and multiphasic machines, from April 2006 through April 2011.
Results: a series of 115 patients was recorded, ages 8 to 83 years, in whom renal and extrarenal inflammatory findings were established by CT. 104 (91%) multiphasic abdominopelvic CT studies corroborated kidney inflammation as an incidental finding. The pattern of multifocal, diffuse inflammation, characterized by two or more (multiple) cortical, focal, defined areas of hypodensity, which did not condition partial volume gain, with loss of cortex-medulla differentiation and more evident in the venous phase, was the most common, being identified in 34% of cases. Second in frequency (23%) was the pattern of single inflammation, with rounded morphology characterized as a cortical, focal, delimited area of hypodensity and shown in the different phases of the study, cuneiform (triangular) morphology, or both. Extrarenal manifestations of acute inflammatory renal pathology associated with the characteristic changes of acute pyelonephritis were identified in 37% of the cases, which represents a high percentage that conditions errors in diagnosis.
Conclusion: multisection, multiphasic CT is indispensable in evaluating patients with acute abdominal pain of clinically undetermined, etiology. This imaging methodology is the primary tool: useful, fast, and effective, to approach unsuspected renal impairment that conditions abdominal pain, as it helps to accurately identify the extent of the process and its extrarenal manifestations.

REFERENCES

1. Motta-Ramírez GA y Ovando-Arellano EJ. ¿Dolor abdominal?: La pielonefritis como una posibilidad diagnóstica. An Radiol Mex 2006;3:221-229.

2. Craig WD, Wagner BJ y Travis MD. Pyelonephritis: Radiologic- pathologic review. Radiographics 2008;28:255-276.

3. Mackersie AB, Lane MJ, Claypool HA et al. Helical CT compared with three-view acute abdominal series. Radiology 2005;237:114-122.

4. Siewert B, Raptopoulos V, Mueller MF, et al. Impact of CT on diagnosis and management of acute abdomen in patients initially treated without surgery. AJR 1997;168:173– 178.

5. Kawashima A, Sandler CM, Goldman SM et al. CT of renal inflammatory disease. Radiographics 1997;17:851-866.

6. Vollmann R, Schaffler GJ, Spreizer C, Quehenberger F y Schoellnast H. Clinical significance of periportal tracking as an external manifestation of acute pyelonephritis. Abdom Imaging 2011;36(5):557-560.

7. Zissin R, Kots E, Rachmani R, Hadari R y Shapiro-Feinberg M. Hepatic periportal tracking associated with severe acute pyelonephritis. Abdom Imaging 2000;25:251-254.

8. Ly JN y Miller FH. Periportal contrast enhancement and abnormal signal intensity on state-of-the-art MRI. AJR 2001;176:891-897.

9. Talner LB, Davidson AJ, Lebowitz RL, Dalla Palma L y Goldman SM. Acute pyelonephritis: Can we agree on terminology? Radiology 1994;192:297–305.

10. Motta-Ramirez GA y Uscanga-Carmona MC. Puntos clínicos de Murphy, McBurney y Giordano: Valor actual y su correlación con la ultrasonografía. An Radiol Mex 2002;2:409-416.

11. Talner LB. Imaging in acute renal infection. RSNA Categorical course in genitourinary radiology 1994; pp 39-48.

12. Rubenstein JN y Schaeffer AJ. Managing complicated urinary tract infectious. The urologic view. Infect Dis Clin N Am 2003;17:333-351.

13. Katz DS, Hines J, Rausch DR, et al. Unenhanced helical CT for suspected renal colic. AJR 1999;173:425–430.

14. Saunders HS, Dyer RB, Shifrin RY et al. The CT nephrogram: Implications for evaluation of urinary tract disease. Radiographics 1995;15:1069-1085.

15. Kocakoc E, Bhatt S y Dogra VS. Renal multidetector row CT. Radiol Clin N Am 2005;43:1021-1047.

16. Joudi FN, Kuehn DM y Williams RD. Maximizing clinical information obtained by CT. Urol Clin N Am 2006;33:287- 300.

17. Bino M y Krestin GP. Cap.9: Dolor en el flanco y en la espalda. En el libro: Abdomen Agudo. Krestin GP y Choyke PL. Edit. Marban1997:115-136.

18. Kawashima A, Sandler CM, Ernst R, Goldman S, Raval B y Hishman EK. CT evaluation of renal infection. Postgraduate Radiology 1998;18:129-148.

19. Leschka S, Alkadhi H, Wildermuth S y Marincek B. Multi-detector computed tomography of acute abdomen. Eur Radiol 2005;12:2435-2447.

20. Kawashima A y LeRoy A. Radiology evaluation of patients with renal infections. Infect Dis Clin N Am 2003;17:433- 456.