CASE 2

Courtesy of Dr. Bakhsh Hospital, Jeddah, Saudi Arabia

34-year-old female with abdominal pain and fever

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---

CASE 2 ANSWER

Right Acute Pyelonephritis

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The corticomedullary (yellow circle) and the excretory (red circle) phases show heterogeneous enhancement of an enlarged right kidney, with perinephritic fluid and fat stranding (arrows). The wedge-shaped hypodensities and striated appearance of the right renal parenchyma is typically more apparent on the excretory phase

Key Points

• Causes of a striated nephrogram include acute pyelonephritis, acute vascular obstruction, acute ureteric obstruction, and acute tubular necrosis.

• CT phases of a renal protocol: Early 'arterial' (15-20 sec post IV injection), corticomedullary 'angiographic' (30-40 sec post IV injection), nephrographic (80-120 sec post IV injection), and late 'delayed / excretory / urographic' (3-5 min post IV injection) phases.

• Striated nephrogram is best seen on nephrographic or delayed phases.

• Exclude renal or perirenal abscesses in cases of renal infections.