Presentation
Diabetes, fever, and left flank pain.
Patient Data
CT shows an enlarged left kidney with heterogeneous contrast enhancement. There are bubbly and linear streaks of gas within renal parenchyma and perinephric space. Left perinephric fat stranding.
Blood test: WBC 15G/l. Glucose 24mmol/l. Creatinin 143µmol/l. CRP 520 mg/l
Blood culture: Klebsiella pneumonia
Differential Diagnosis (imaging)
Emphysematous pyelitis, which is isolated gas production inside the excretory system is a relatively benign entity. Emphysematous pyelonephritis, which is gas production from an infection in the renal parenchyma rather than just in the collecting system, if not treated early, it may lead to fulminant sepsis and, therefore, carries a high mortality.
Iatrogenic (instrumentation, or intervention of urinary tract).
Fistulous communication with bowel.
Case Discussion
The history, symptoms, and CT findings are consistent with emphysematous pyelonephritis.
This case can be classified as type 2 or 3a according to the Huang-Tseng CT classification system (see the main article). The causative organism was found to be Klebsiella pneumonia.
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