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Perinephric Fat Stranding on Postmortem Computed Tomography Scan in Acute Pyelonephritis

A Case Report

Garland, Jack BMed*; Olds, Kelly BHSc; Tse, Rexson FRCPA

The American Journal of Forensic Medicine and Pathology: May 14, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PAF.0000000000000489
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Infection/inflammation of solid organ can be difficult to appreciate at postmortem computed tomography (CT) scan (PMCT). Perinephric fat stranding is a clinical CT finding to suggest pyelonephritis; however, PMCT scan showing perinephric fat stranding in acute pyelonephritis has not been documented in the forensic literature. We present a death from acute pyelonephritis in a setting of hypertensive heart disease, in which the unenhanced PMCT performed before postmortem examination was able to show florid bilateral perinephric fat stranding. This PMCT finding subsequently guided the pathologist to pay special attention to the kidney and take appropriate microbiology specimens to confirm the diagnosis. Perinephric fat stranding on PMCT may be a useful sign to alert the pathologist to consider acute pyelonephritis during the postmortem examination.

From the *Forensic & Analytical Science Service, NSW Health Pathology, New South Wales;

School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia; and

Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand.

Manuscript received March 6, 2019; accepted March 26, 2019.

The authors report no conflict of interest.

Reprints: Rexson Tse, FRCPA, Department of Forensic Pathology, LabPLUS, Gate 4, Building 31, Auckland City Hospital, Auckland 1148, New Zealand. E-mail: rexson.tse@gmail.com; rexsont@adhb.govt.nz.

© 2019 by Lippincott Williams & Wilkins.