Q: In patients with acute complicated pyelonephritis, a follow-up CT scan should be performed on transfer from ICU to assure resolution of the pathology?
A) Yes
B) No
Answer: B
Acute complicated pyelonephritis is a disease that can be mostly managed with symptoms and urine analysis/culture. Computed Tomography (CT) is the modality of choice in case of need. Patients who are sick and can not travel to the radiology department can be managed with renal ultrasound. For intensivists: a CT scan may show localized hypodense lesions consistent with ischemia, marked neutrophilic infiltration, and swelling (edema).
Patients do not require follow-up imaging, and clinical improvement is sufficient. Hypodensity on CT scan may take up to 12 weeks to resolve.
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References:
1. Kawashima A, LeRoy AJ. Radiologic evaluation of patients with renal infections. Infect Dis Clin North Am 2003; 17:433.
2. Demertzis J, Menias CO. State of the art: imaging of renal infections. Emerg Radiol 2007; 14:13.
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