Pyelonephritis cronic

with gray scale uftrasound. The findings are analogous to those seen pathologically, namely a focal or

muftifocal process with loss of renal parenchyma, retraction of one or more calyces, decrease in renal

size, and increased echoes from fibrosis. In the proper clinical setting, the diagnosis of chronic atrophic

pyelonephritis can be made using ultrasound technique.

Ultrasound is capable of demonstrating fine anatomic detail in the kidney. The renal parenchyma

consists of the cortex, which produces low-level echoes; the pyramids, which are sonolucent; and the

arcuate vessels, which are seen in cross-section as punctate zones of intense echoes at the

corticomedullary junction [1, 2]. The calyces and infundibula, when seen, are best defined as sonolucent

structures within the renal sinus surrounded by echogenic urothelium. The remainder of the renal sinus

contains dense echoes [3]. Most of the literature concerning renal inflammatory disease has dealt with

cases studied using bistable display [4]. This paper demonstrates the ultrasound findings of chronic

atrophic pyelonephritis. These are analogous to the urographic signs and permit the diagnosis to be

made in the proper clinical setting.

In tuberculosis that causes pnc the picture is fragmentasi / terputusnya infundibulum dan caliceys
 Chronic atrophic pyelonephritis has several etiologies. Hodson [5] described it as a focal or

multifocal process with normal intervening areas of kidney. The process may involve the full thickness of

the kidney with retraction of the papilla, dilatation of the surrounding calyx,depression of the surface,

and loss of the renal parenchyma. The involved kidney is often small and the adjacent tissue is normal.
This constellation of findings can be induced by several processes, most commonly vesicoureteral reflux.

Clinical correlation is essential. The ultrasound findings of chronic atrophic pyelonephritis reflect the

pathologic alterations. Focal loss of parenchyma can be appreciated. Collagen is considered to be a

major source of echoes [6]. Focal fibrosis manifested by increased echoes can be demonstrated in the

involved area of the cortex and medulla (fig. 4). The retracted calyx, if not distended with fluid, appears

as anechogenic zone extending beyond the normal area of the renal sinus. When distended with urine,

sonolucent fluid within the calyx or infundibulum may be appreciated. One of our patients had a dense

fibrous band in the parenchyma (fig. 1). The entire scarring process, if advanced, may be global rather

than focal.

Ultrasonic Characteristics of Chronic Atrophic Pyelonephritis

CHESTER J. KAY,’2 ARTHUR T. ROSENFIELD,2 KENNETH J. W. TAYLOR,2 AND MURRAY A. ROSENBERG’