E5216. Multimodality Imaging Approach to Urinary Tract Infection in Children: A Pictorial Review 
  1. Nga Nguyen; University of Texas Medical Branch
  2. Nahyun Jo; University of Texas Medical Branch
  3. Alvin Camacho; University of Texas Medical Branch
Urinary tract infection (UTI) is one of the most common urologic diseases in children. Most UTI originates from the lower urinary tract, usually the urethra and bladder before ascending to the upper urinary tract. In adults, history and laboratory values are the main diagnostic clues. Imaging is reserved for complicated cases. In children, however, symptoms of UTI are variable depending on age. In addition to history and clinical values, imaging plays a critical role because urinary infection can be the first sign of a congenital renal anomaly or rarely, a neoplastic process. Therefore, a mental checklist of differential diagnosis is needed to solidify final imaging interpretations.

Educational Goals / Teaching Points
After reading this educational exhibit, the reader will be able recall basic collecting system anatomy, appreciate current imaging recommendations for pediatric UTI, understand pros and cons of each imaging modality, describe imaging features of common predisposing factors and congenital anomalies, and acknowledge complications and long-term sequalae of untreated UTI in children.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Multimodality imaging, including ultrasound, fluoroscopy, nuclear medicine, CT, and MRI, to further characterize the urinary tract will be discussed using a case-based approach. Understanding which questions that a specific modality can answer helps providers choose the most appropriate study. Common pathologies that predispose children to UTI, including ectopic kidney, fusion renal parenchyma, ureteropelvic junction obstruction, vesicoureteral reflux, megaureter, posterior urethral valve, and duplicated collecting system will be described. Complications such as pyelonephritis, renal abscess, and nephrolithiasis and long-term sequelae, such as chronic kidney disease, parenchymal scarring, and hypertension will also be reviewed.

Pediatric UTI can be complicated by multiple predisposing factors and congenital anomalies. Understanding of the associated imaging features is key to accurate diagnoses, which help prevent long-term complications and facilitate prompt surgical intervention, if indicated.