Pyelonephritis: a normal scan can be normal

Question 1A febrile patient with flank pain and a positive urine test has a normal-looking kidney on ultrasound. What do you conclude?

1. aThe urine result is wrong
2. bPyelonephritis is still possible
3. cThe pain is musculoskeletal
4. dPyelonephritis is excluded

Question 2What is the most important finding to look for in suspected pyelonephritis?

1. aRenal artery flow
2. bCortical brightness
3. cHydronephrosis, suggesting an obstructed, infected kidney
4. dKidney length to the nearest millimetre

Question 3Bright echoes with dirty shadowing within the kidney of a diabetic patient suggest what?

1. aMirror artefact
2. bA simple cyst
3. cEmphysematous pyelonephritis
4. dNormal renal sinus fat

Question 4Why scan the bladder in suspected pyelonephritis?

1. aIt is not needed
2. bTo measure kidney length
3. cTo exclude appendicitis
4. dRetention can cause obstruction and infection upstream

Question 5Hydronephrosis with layering echoes in the collecting system in a septic patient suggests what?

1. aA normal variant
2. bPyonephrosis, which needs urgent drainage
3. cSimple hydronephrosis only
4. dA renal cyst