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A 19-year-old primigravida presented with fever and right-flank pain at 22 weeks of gestation. She was found to have pyelonephritis and underwent renal ultrasonography. The scan showed maximal caliceal dilatation of 23 mm in the right kidney. Since this is greater than what is expected at 22 weeks of gestation, a single-shot intravenous pyelogram was obtained. The radiograph showed a right ureteral obstruction located 4 cm from the renal pelvis, at the level of the head of the fetus, which was in the breech presentation (arrows). There was no evidence of renal calculi. The patient was placed in the left lateral position, started on intravenous antibiotics, and hydrated. A repeated abdominal radiograph that was obtained eight hours later showed that the fetus was in the cephalic presentation with clearance of contrast material from the renal collecting system. The patient completed a 10-day course of ceftriaxone and went on to deliver a healthy, full-term infant without subsequent episodes of urinary tract infection. Pyelonephritis is a common medical complication of pregnancy that is attributed to mechanical compression of the urinary collection system by the gravid uterus, as well as to a decrease in ureteral motility mediated by progesterone.
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