Pyonephrosis is a urological emergency. An obstructed kidney is prone to become infected. High fever and loin pain can suggest obstructive pyonephrosis. Pus or pus cells may also be detected in the urine. Low level echoes can be seen within thedilated PCS on ultrasound, and may represent pus. Sometimes, however, the urine may appear anechoic, despite being infected. The clinical history should help differentiate pyo- from simple hydronephrosis (Fig. 7.13A). Percutaneous drainage by ultrasound or fluoroscopically guided nephrostomy is usually necessary, partly as diagnostic confirmation and partly as a therapeutic procedure.
Ultrasound images of Pyonephrosis. Low-level echoes from pus can be seen in the dilated PCS. (Note that absence of echoes does not exclude pyonephrosis.)
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