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Emphysematous pyelonephritis

Case contributed by Ayush Goel
Diagnosis certain

Presentation

Vomiting and generalized pain abdomen for 2 days.

Patient Data

Age: 65 years
Gender: Female

Extensive air pockets in the left renal parenchyma and calyceal system. The gas tracks through the perirenal space into the posterior pararenal space.

Note: IV contrast was not given as the urea and creatinine values were high.

Rectal contrast was administered to rule out any large bowel pathology.

Case Discussion

Emphysematous pyelonephritis is a morbid infection of the kidneys, with characteristic gas formation within or around the kidneys. If not treated early, it may lead to fulminant sepsis with significant mortality.

Causative organisms include:

  • E. Coli - usually considered the commonest causative organism
  • Klebsiella pneumonia
  • Proteus mirabilis

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