title: Relationship between uncommon computed tomography findings and clinical aspects in patients with acute pyelonephritis.
abstract: OBJECTIVE
  Computed tomography (CT) has become popular in the diagnosis of acute pyelonephritis (APN) and its related complications in adults. The aim of this study was to investigate the relationship between uncommon CT findings and clinical and laboratory data in patients with APN.
  
  
  METHODS
  From July 2009 to July 2012, CT findings and clinical data were collected from 125 female patients with APN. The six uncommon CT findings (excluding a wedge-shaped area of hypoperfusion in the renal parenchyma) studied were perirenal fat infiltration, ureteral wall edema, renal abscess formation, pelvic ascites, periportal edema, and renal scarring. The clinical parameters analyzed were the age and body mass index of the patients as well as the degree and duration of fever. Laboratory parameters related to inflammation and infection included white blood cell count, C-reactive protein (CRP) level, erythrocyte sedimentation rate, pyuria, and bacteriuria.
  
  
  RESULTS
  The most common CT finding was perirenal fat infiltration (69 cases, 55%). A longer duration of fever, higher CRP level, and grade of pyuria were related with perirenal fat infiltration (p=0.010, p=0.003, and p=0.049, respectively). The CRP level was significantly higher in patients with renal abscess and ureteral wall edema (p=0.005 and p=0.015, respectively).
  
  
  CONCLUSIONS
  The uncommon CT findings that were related to aggravated clinical and laboratory parameters of APN patients were perirenal fat infiltration, ureteral wall edema, and renal abscess formation. The inflammatory reaction and tissue destruction may be more aggressive in patients with these CT findings.
authors.affiliation: Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Jang Sik
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Sangwook
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Kwang Woo
authors.initials: KW
authors.lastname: Lee
authors.affiliation: Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Jun Mo
authors.initials: JM
authors.lastname: Kim
authors.affiliation: Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors.forename: Min Eui
authors.initials: ME
authors.lastname: Kim
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging / Q000209:etiology; D000208:Acute Disease; D000273:Adipose Tissue / Q000000981:diagnostic imaging / Q000473:pathology; D000328:Adult; D004487:Edema / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000000981:diagnostic imaging; D008875:Middle Aged; D011704:Pyelonephritis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D014515:Ureteral Diseases / Q000000981:diagnostic imaging / Q000209:etiology
keywords: Pyelonephritis; X-ray computed tomography