Urologic emergencies such as Fournier gangrene, testicular torsion and rupture, priapism, and pyonephrosis are life threatening and need urgent diagnosis and attention. This exhibit will review the essential sonographic features of these conditions and others for radiologists to recognize and to deliver a timely diagnosis.

Ultrasonography (US) is often the preferred initial imaging modality for urologic emergencies as it allows for rapid assessment of acute clinical presentations that require prompt recognition and management. 

Pyelonephritis, infection of the renal collecting system and renal parenchyma, is usually due to ascending infection up the ureter and into the kidney (85%). Hematogenous seeding (15%) is less common and usually occurs in the setting of intravenous drug use or endocarditis (4). Patients commonly present with flank pain and fever and diagnosis is usually clinical (pyuria, bacteriuria/bacteremia, urine culture). Uncomplicated cases of pyelonephritis are treated effectively with appropriate antibiotics. Imaging is utilized when symptoms or laboratory abnormalities persist. The majority of patients with acute pyelonephritis cases have no corresponding...

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As ultrasound is often the initial imaging modality utilized, radiologists must familiarize themselves with the sonographic features of urologic emergencies. This familiarity will help facilitate prompt triaging for appropriate surgical and medical management.