I believe so: I am not a radiologist, but as a pathologist i can assure you that i've seen cases of pyelonephritis that i'd think are are too subtle anatomically to show on x-rays. White cell casts in the urine establish the diagnosis, and if there's white cells in the urine and flank pain and fever, the presumptive diagnosis is kidney infection, imaging or no.
Answered 12/18/2013
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