Febrile urinary infection in an 18-month-old girl
History
18-month-old girl admitted with fever of 39.6 °C, vomiting and irritability; catheter urine grew E. coli and CRP was 142 mg/L. Ultrasound on day 2: normal-sized kidneys, no dilatation. She improved on intravenous antibiotics. The paediatric team requested DMSA on day 4 to confirm renal involvement.
Step 1 · Acute DMSA
The left upper pole has an area of reduced uptake with indistinct margins. The renal outline is preserved, the kidney is not small and differential uptake is within the normal range. What does the left upper-pole appearance represent?