Preliminary Diagnosis: Perinephric Abscess
I. What imaging technique is first-line for this diagnosis?
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Multiplanar IV contrasted CT of the abdomen and pelvis
II. Describe the advantages and disadvantages of this technique for diagnosis of perinephric abscess.
Multiplanar IV contrasted CT of the abdomen and pelvis
Advantages
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Highly sensitive and specific in detecting and detailing a primary perinephric inflammatory or infectious process and detailing any secondary complications
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May help guide treatment and therapy
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May help evaluate for any vascular or osseous extension of infection
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Offers exquisite detail on the extension of the infectious process
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May help locate gas within the perinephric process often consistent with and highly specific for an infectious process
Disadvantages
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Exposes patients to ionizing radiation
III. What are the contraindications for the first-line imaging technique?
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May be contraindicated in pregnant patients.
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Relative contraindication in patients with renal failure (IV contrast) and those with a contrast allergy
IV. What alternative imaging techniques are available?
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MR of the abdomen and pelvis with IV contrast
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Ultrasound
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of perinephric abscess.
MR of the abdomen and pelvis with IV contrast
Advantages
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Offers exquisite detail of the surrounding soft tissues
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Does not expose patients to ionizing radiation
Disadvantages
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Expensive
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Time consuming
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May be subject to motion and susceptibility-weighted artifact degrading image quality
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Offers less exquisite detail of the surrounding vascular and osseous structures compared with CT imaging
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Less adept in guiding treatment compared with companion CT imaging
Ultrasound
Advantages
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Highly portable and relatively inexpensive imaging modality
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Does not expose patients to ionizing radiation
Disadvantages
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Less sensitive and specific in detailing and detecting the primary pathological process and detailing any secondary complications
VI. What are the contraindications for the alternative imaging techniques?
MR of the abdomen and pelvis with IV contrast
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Contraindicated in patients with non–MR-compatible hardware
Ultrasound
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No specific contraindications exist.
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