TY - JOUR ID - 14242 TI - Localization of acute pyelonephritis in pyrexia of unknown origin using FDG PET/CT JO - Asia Oceania Journal of Nuclear Medicine and Biology JA - AOJNMB LA - en SN - 2322-5718 AU - Solav, Shrikant AU - savale, shailendra AU - Mahaveer Patil, Abhijit AD - SPECT Lab, Nuclear Medicine Services, Pune, Maharashtra, India Y1 - 2020 PY - 2020 VL - 8 IS - 1 SP - 79 EP - 83 KW - Pyelonephritis KW - PUO KW - 18F-FDG PET CT scan KW - 99mTc DMSA DO - 10.22038/aojnmb.2019.14242 N2 - Objective(s): Acute pyelonephritis presents with high-grade fever, dysuria, flank pain, leukocytosis, and microscopic hematuria. Urine culture aids in the diagnosis of this infection. It can be complicated or uncomplicated. Complicated pyelonephritis includes uncontrolled diabetes, transplant, pregnancy, acute or chronic renal failure, structural abnormality of the urinary tract, immunocompromised state, and hospital-acquired infections. Gram-negative bacteria commonly involved are Escherichia, Klebsiella, Proteus, and Enterobacter. TheFDG PET/CT helps detect occult causes of fever, such as skeletal tuberculosis, thyroiditis, and lymphoma, when other investigations are inconclusive. We present three cases of pyrexia of unknown originĀ (PUO) in whom FDG PET/CT helped localize the focus of infection in the kidneys. Methods: The18F-FDG PET/CT was performed on all three cases and images were acquired using the Biograph Horizon PET/CT system. Results: A cortical-based focus of FDG uptake was localized in the kidneys. The focus of abnormality was persistent following diuretic administration at 1-hour delayed regional image. Two cases had supportive evidence of pyelonephritis on DMSA scan. One case also had frank pus drained after DJ stenting of the affected side. All of them responded to treatment. Conclusion: Physiologic excretion of FDG in the urinary tract may interfere with the detection of the focus of infection in the kidneys on FDG PET/CT. However, occult infection in the kidneys may be detected with adequate precautions, such as the use of diuretics and delayed imaging, as illustrated in this case report. Routine investigations were noncontributory in all three cases presenting with PUO. However, FDG PET provided a diagnostic clue for pyelonephritis. UR - https://aojnmb.mums.ac.ir/article_14242.html L1 - https://aojnmb.mums.ac.ir/article_14242_9132a98250ce00e6a290a59a5926301d.pdf ER -