Total Papillary Necrosis

Normal

Renal Papillary Necrosis— Papillary Form

Lesion

Early necrosis, mucosa normal, papilla swollen.

Progressive necrosis, swelling, mucosal loss.

Sequestrian of necrotic area.

Sinus formation begins.

Sinus surrounds sequestrum.

Sequestrum extruded or resorbed.

Normal

Renal Papillary Necrosis— Papillary Form

Sequestrum calcifies.

Extruded sequestrum

Extruded sequestrum

Sequestrum calcifies.

Pyelogram

Normal calyx

Irregular or fuzzy calyx

Sinus or "Arc Shadow"

"Ring Shadow"

"Clubbing" "Clubbed calyx" "Caliectasis"

"Ring Shadow" Obstruction

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