Acute complicated pyelonephritis: contrast-enhanced ultrasound.

Imaging is required if complication is suspected in acute pyelonephritis to assess the nature and extent of the lesions, and to detect underlying causes. The current imaging modality of choice in clinical practice is computed tomography. Because of associated radiation and potential nephrotoxicity, CEUS is an alternative that has been proven to be equally accurate in the detection of acute pyelonephritis renal lesions. The aims of this study of 48 patients are to describe in detail the CEUS findings in acute pyelonephritis, and to determine if abscess and focal pyelonephritis may be distinguished. Very characteristic morphologic and temporal patterns of enhancement are described. These allow differentiation of focal pyelonephritis from renal abscess, and detection of tiny suppurative foci within focal pyelonephritis. The detection of abscesses is important because follow-up in 25 patients revealed a longer clinical course. Typical pyelonephritis CEUS features permit distinction from other renal lesions. As a whole, CEUS is an excellent tool in the work-up of complicated acute pyelonephritis, so it may be considered as the imaging technique of choice in the evaluation and follow-up of these patients who frequently are very young, so as to minimise radiation exposure.

Wandering spleen torsion-use of contrast-enhanced ultrasound.

We report a case of torsion of a wandering spleen in an 18-year-old male patient who presented with acute abdominal pain and left lower quadrant mass. The patient was initially misdiagnosed at another institution. The patient came to our hospital for further investigation. Contrast-enhanced ultrasound was performed and showed a solid hypoechoic avascular mass, which was all that remained of the spleen, located under the left kidney. Based on the ultrasound findings, CT scan and MRI of the abdomen were performed to confirm the suspicion of torsion of a wandering spleen. To the best of our knowledge, there are no case reports describing the use of contrast-enhanced ultrasound for diagnosing torsion of a wandering spleen.