Case 19
Clinical Presentation
A 28-year-old woman with flank pain and fever for 1 week.
Imaging Findings
Contrast-enhanced computed tomography (CT) image of the abdomen in the region of the kidneys shows an irregular fluid collection (arrow) in the left renal parenchyma with extension into the perinephric space (arrowhead). The wall of the collection shows smooth enhancement. Perinephric stranding is present in the region of the collection (asterisk). The right kidney is not included in the image.
Differential Diagnosis
• Renal abscess complicating acute pyelonephritis: An intrarenal fluid collection with smoothly enhancing walls and perinephric extension is characteristic of a renal abscess.
• Renal neoplasm: Renal neoplasms may have a cystic appearance. However, smooth enhancement of the wall is not a typical feature. Enhancement is usually heterogeneous. Internal septa may be present. Extension of fluid into the perinephric space is not expected.
• Complicated renal cortical cyst:
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