Fraley's syndrome: case report and update on current diagnostic methods

A 38-year-old woman presented with fever, right flank pain, and a clinical diagnosis of pyelonephritis. Work-up revealed the presence of a crossing arterial branch causing obstruction of the superior infundibulum of the right kidney, which is an uncommon cause of nephralgia and urinary infection initially described by Fraley in 1966. Intravenous urography, retrograde pyelography, and angiography remain the mainstay of diagnosis, much as in the initial descriptions of this entity. [131I]Hippuran imaging, with analysis of the upper and lower pole regions of interest, provides a simple yet powerful method of evaluating functional and excretory changes in the superior infundibulum, and has proved more efficacious than previously reported whole-kidney renograms. Renal scintigraphy represents a relatively noninvasive method of serial functional examination in this disorder. Ultrasound imaging, by monitoring upper-pole dilatation, may provide complementary morphologic information important for long-term follow-up.