0:00

This is a patient who has a renal transplant and

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has a rising white blood cell count. They're

0:06

worried about an infectious ideology. We've gotten

0:09

ultrasound that was unrevealing. This was followed

0:12

by a CT scan and as we scroll down we're going to

0:15

go all the way down to the pelvis we could first of all see the native kidneys are

0:18

quite a trophic and so certainly they're not functioning. You

0:21

can see this renal transplant place in the right lower quadrant

0:24

on this cut over here to a little bit of stranding associated

0:27

with it. So that may close into what we're about to see as we

0:30

go down lower. Look at this portion of

0:33

the renal transplant. It just compare it to the side more

0:36

medially this portion quite heterogeneous hypotenuating

0:39

and appearance. There's some striations

0:42

as well as we go through it.

0:44

And so this beer and just quite characteristic of

0:47

focal pileonephritis, and you can

0:50

see the inflammatory change associated with it.

0:53

Which would be consistent with that diagnosis now

0:56

important to remember that, you know, certainly real

0:59

transplant patients can get pilot nephritis and

1:02

it can happen up to about 25% of patients within

1:05

the first year of their surgery E. Coli

1:08

is the most common organism and ultrasound is

1:11

often used as the first line Imaging modality.

1:14

To evaluate these patients, but in terms of just pilot nephritis findings

1:17

are often non-specific. You can

1:20

see areas of more hypoecogenicity as

1:24

there is increased edema within the kidney. So that's how one

1:27

way it would manifest but oftentimes you're not

1:31

really going to see it that nicely and so if you're really worried about it,

1:35

It certainly can be perhaps diagnosed clinically. But

1:38

if you want to look at the kidney itself, you want to see how much kidney is inflamed.

1:41

You want to see if there's complications such as abscesses, you

1:44

know, CT scan would be the way to go and and this

1:47

instance you can see Apache nephrogram areas

1:50

of striations. You may also see thickening of the urothelial lining

1:53

if you actually look at this, you're really aligning here it's subtle

1:56

but it's a little bit more thick than you'd expect, you know these instances

1:59

and in hyper enhancing as well. And so all these findings are

2:02

compatible with pile and ephritis and pylitis

2:05

in this instance.