Diagnostic ultrasound ( PDFDrive )

CHAPTER 9 The Kidney and Urinary Tract 323
Anomalies Related to Urethral
Development: Diverticula
he majority of urethral diverticula are acquired secondary
to injury or infection, although congenital diverticula occur
rarely. Most urethral diverticula in women form as a result of
infection of the periurethral glands; some may be related to
childbirth. Most diverticula are found in the midurethra and
are bilateral. Oten, a luctuant anterior vaginal mass is felt.
Stones may develop because of urinary stasis. Transvaginal
or translabial scanning may demonstrate a simple or complex
cystic structure communicating with the urethra through a thin
neck (Fig. 9.18).
A
C
FIG. 9.17 Congenital Urachal Anomalies. (A) Patent urachus extends
from the bladder to the umbilicus. (B) Urachal sinus. (C) Urachal
diverticulum. (D) Urachal cyst.
B
D
GENITOURINARY INFECTIONS
Pyelonephritis
Acute Pyelonephritis
Acute pyelonephritis is a tubulointerstitial inlammation of the
kidney. Two routes may lead to inlammation: ascending infection
(85%; e.g., Escherichia coli) and hematogenous seeding (15%;
e.g., Staphylococcus aureus). Women age 15 to 35 years are most
oten afected 25 ; 2% of pregnant women will develop acute
pyelonephritis. 26 Most adults present with lank pain and fever
and can be diagnosed clinically with the aid of laboratory studies
(bacteriuria, pyuria, and leukocytosis). With appropriate antibiotics,
both clinical and laboratory indings show rapid improvement.
Imaging is necessary only when symptoms and laboratory
abnormalities persist: imaging is useful to identify potential causes
of insuiciently treated infection, including renal and perirenal
abscesses, calculi, and urinary obstruction. he Society of
Uroradiology proposed using acute pyelonephritis to describe
acutely infected kidneys, eliminating the need for terms such as
bacterial nephritis, lobar nephronia, renal cellulitis, lobar nephritis,
renal phlegmon, and renal carbuncle. 27
A
B
FIG. 9.18 Urethral Diverticulum in Young Woman With Palpable Vaginal Mass. (A) Sagittal and (B) transverse translabial sonograms show
a complex cystic mass adjacent to the anterior urethra.