Presentation
Bilateral loin pain and fever. The patient has chronic uncontrolled diabetes.
Patient Data
The left kidney is enlarged showing loss of its architecture associated with heterogeneous attenuation with loss of tissue differentiation, hyperdense contents of the pelvicalyceal system containing two lower calyceal stones, multiple cortical cysts and diffuse stranding of the surrounding fat planes with nodular thickening of the perirenal fascia notably the posterior one. Soft tissue density mass lesion noted at the posterior pararenal space destructing the left 12th rib with extension of the paraspinal muscles and subcutaneous tissue of the back. Multiple left para-aortic and renal hilar lymph nodes are noted, some of them showing dense calcification, others are in close proximity and inseparable from the left kidney (xanthogranulomatous pyelonephritis).
The left ureter showed obstructing stone at its lower third associated with proximal dilatation of the left ureter showing pneumo-ureter and mural thickening (emphysematous ureteritis).
The right kidney showed air foci within the pelvicalyceal system extending to the right ureter (emphysematous pyelitis and uretritis). Also, there is small lower calyceal stone and lower pole simple cortical cyst.
The urinary bladder showed diffuse mural thickening with intra-luminal and mural air extending to the right vesicoureteric junction (emphysematous cystitis).
Incidental findings: Calculous gallbladder disease, right supra-renal adenoma and left sided pleural effusion with underlying consolidation collapse.
Case Discussion
This case shows right emphysematous pyelitis, bilateral ureteritis and cystitis as well as left xanthogranulomatous pyelonephritis. These are serious infections that can be life-threatening. An immunocompromised state is the most common predisposing condition. This patient had a history of chronic uncontrolled diabetes.
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