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Emphysematous pyelitis

Emphysematous pyelitis is defined as isolated gas production inside the excretory system, secondary to acute bacterial infection1. It is relatively benign entity, and needs accurate differentiation from emphysematous pyelonephritis, which is much morbid condition. It has excellent prognosis with good response to medical management 1.

Epidemiology and clinical presentation

Disease is more common in female2, associated with diabetes and urinary tract obstruction. Symptoms are usually mild, with fever and chills. Sometimes flank tenderness with dysuria is present.

Pathology

Aetiology

E. coli, Klebsiella, Aerobacter aerogenes and Proteus mirabilis are the commonest causative organisms.

Radiologic features

Plain film

Retroperitoneal gas is seen in many patients. Associated urolithiasis, if any, may also be seen.

Ultrasound

May show dirty shadowing in pelvicalyceal system.

CT

Gas-fluid level in dilated calyx, usually with mild or no obvious features of pyelonephritis.

Treatment and prognosis

Emphysematous pyelitis genrally carries a good prognosis, and usually respond to intravenous antibiotics followed by oral antibiotics 1.

Differential diagnosis

General considerations include

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