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Emphysematous pyelonephritis

Case contributed by Pradosh Kumar Sarangi , 28 Nov 2015
Diagnosis certain
Changed by Derek Smith, 18 Jan 2018
Back to revision history

Updates to Case Attributes

Age changed from 49 year to 50 years.
Presentation was changed:
One week of left flank pain with fever and dysuria. 8 year history of diabetes mellitus, uncontrolledpoorly controlled for 6 months. Now with flank pain, continuous fever and dysuria for the past 1 week.
Body was changed:

The non-contrast CT findings in this diabetic patientspatient with a history of fever, flank pain, leucocytosis, thrombocytopenia accurately diagnose are consistent with eEmphysematousmphysematous pyelonephritis. It falls intoThe perinephric collections and bubbly foci of air make this type 2 emphysematous pyelonephritis according to the classification byWan etal. Non-contrast CT was performed due to poor renal function (high serum urea and creatinine), with a better prognosis.

  • -<p>The non-contrast CT findings in this diabetic patients with history of fever, flank pain, leucocytosis, thrombocytopenia accurately diagnose <a href="/articles/emphysematous-pyelonephritis">Emphysematous pyelonephritis</a>. It falls into type 2 emphysematous pyelonephritis according to the classification by<strong> </strong>Wan etal. Non-contrast CT was performed due to poor renal function (high serum urea and creatinine).</p>
  • +<p>The non-contrast CT findings in this diabetic patient with a history of fever, flank pain, leucocytosis, thrombocytopenia are consistent with <a title="Emphysematous pyelonephritis" href="/articles/emphysematous-pyelonephritis">e</a><a href="/articles/emphysematous-pyelonephritis">mphysematous pyelonephritis</a>. The perinephric collections and bubbly foci of air make this type 2, with a better prognosis.</p>

References changed:

  • 1. Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics. 2008;28 (1): 255-77. <a href="http://dx.doi.org/10.1148/rg.281075171">doi:10.1148/rg.281075171</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/18203942">Pubmed citation</a><span class="auto"></span>
  • 1. Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics. 2008;28 (1): 255-77. <a href="http://dx.doi.org/10.1148/rg.281075171">doi:10.1148/rg.281075171</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/18203942">Pubmed citation</a><span class="auto"></span>
  • 3. Grayson DE, Abbott RM, Levy AD et-al. Emphysematous infections of the abdomen and pelvis: a pictorial review. Radiographics. 2002;22 (3): 543-61. <a href="http://dx.doi.org/10.1148/radiographics.22.3.g02ma06543">doi:10.1148/radiographics.22.3.g02ma06543</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/12006686">Pubmed citation</a><span class="auto"></span>
  • 3. Grayson DE, Abbott RM, Levy AD et-al. Emphysematous infections of the abdomen and pelvis: a pictorial review. Radiographics. 2002;22 (3): 543-61. <a href="http://dx.doi.org/10.1148/radiographics.22.3.g02ma06543">doi:10.1148/radiographics.22.3.g02ma06543</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/12006686">Pubmed citation</a><span class="auto"></span>
  • 2. Wan YL, Lee TY, Bullard MJ, Tsai CC. Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome. (1996) Radiology. 198 (2): 433-8. <a href="https://doi.org/10.1148/radiology.198.2.8596845">doi:10.1148/radiology.198.2.8596845</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/8596845">Pubmed</a> <span class="ref_v4"></span>
  • 2. Wan YL, Lee TY, Bullard MJ, Tsai CC. Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome. (1996) Radiology. 198 (2): 433-8. <a href="https://doi.org/10.1148/radiology.198.2.8596845">doi:10.1148/radiology.198.2.8596845</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/8596845">Pubmed</a> <span class="ref_v4"></span>
  • 1.Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics. 2008;28 (1): 255-77. <a href="http://dx.doi.org/10.1148/rg.281075171">doi:10.1148/rg.281075171</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/18203942">Pubmed citation</a><span class="auto"></span>
  • 1. Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics. 2008;28 (1): 255-77. <a href="http://dx.doi.org/10.1148/rg.281075171">doi:10.1148/rg.281075171</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/18203942">Pubmed citation</a><span class="auto"></span>
  • 2.Grayson DE, Abbott RM, Levy AD et-al. Emphysematous infections of the abdomen and pelvis: a pictorial review. Radiographics. 2002;22 (3): 543-61. <a href="http://dx.doi.org/10.1148/radiographics.22.3.g02ma06543">doi:10.1148/radiographics.22.3.g02ma06543</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/12006686">Pubmed citation</a><span class="auto"></span>
  • 2. Grayson DE, Abbott RM, Levy AD et-al. Emphysematous infections of the abdomen and pelvis: a pictorial review. Radiographics. 2002;22 (3): 543-61. <a href="http://dx.doi.org/10.1148/radiographics.22.3.g02ma06543">doi:10.1148/radiographics.22.3.g02ma06543</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/12006686">Pubmed citation</a><span class="auto"></span>
  • 3.Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch. Intern. Med. 2000;160 (6): 797-805. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10737279">Pubmed citation</a><span class="auto"></span>
  • 3. Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch. Intern. Med. 2000;160 (6): 797-805. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10737279">Pubmed citation</a><span class="auto"></span>
  • 4. Wan YL, Lee TY, Bullard MJ, Tsai CC. Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome. (1996) Radiology. 198 (2): 433-8. <a href="https://doi.org/10.1148/radiology.198.2.8596845">doi:10.1148/radiology.198.2.8596845</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/8596845">Pubmed</a> <span class="ref_v4"></span>

Updates to Study Attributes

Findings was changed:

NCCT showing  leftLeft renal enlargement with architectural distortion. There isare bubbly and linear streaks of air within renal parenchyma and perinephric space with intra renalan intrarenal fluid collection. Bilateral perinephric fat stranding and thickening of gerotaGerota fascia noted (more in left kidney)

Images Changes:

Image CT (non-contrast) ( update )

Description was changed:
Enlarged left kidney with air in renal parenchyma and perinephric space. Perinephric fat stranding and thickening of gerotaGerota fascia.Left. Left pleural effusion.

Updates to Quizquestion Attributes

Question was changed:
There are 2 distinctsdistinct types of emphysematous pyelonephritis according to Wan etalet al. Which one is associated with poora poorer prognosis?
Answer was changed:
Type 1 is associated with poora poorer prognosis.The. The mortality rate is 69%in type 1 as compared to 18% in type 2.

Updates to Quizquestion Attributes

Answer was changed:
CT scan is best (this was non-contrast due to the patient's poor renal function)

Updates to Quizquestion Attributes

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