99 Renal infarction and pyelonephritis can occasionally be difficult to differentiate by imaging as they can both cause wedge-shaped areas of decreased renal enhancement. The cortical rim sign is seen in renal infarction and not pyelonephritis. The cortical rim sign refers to perfusion of an intact subcapsular renal cortex (2 to 4 mm) supplied by collateral capsular circulation. However, the cortical rim sign is only seen in ~50% of infarcts.1 It is also not seen immediately after infarction. In posttraumatic renal infarction, the earliest appearance is within 8 h and the median time to appearance is 7 days.2
Renal Infarction versus Pyelonephritis
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