Differential Diagnosis: Pyelonephritis

Pyelonephritis with clinical symptoms mimicking appendicitis.

9 year old girl presented to the emergency department with a five day history of intermittent fever, right sided abdominal pain, and emesis. Her past medical history included two prior urinary tract infections. CT examination, shown below, was requested to exclude atypical appendicitis.

Contrast-enhanced axial CT image demonstrates patchy perfusion of the right kidney (arrow). Note homogeneous perfusion to the left kidney (L). The appendix (not shown) appeared normal.
Blood and urine cultures grew E. coli; the patient responded to intravenous antibiotics.

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