Emphysematous pyelitis is defined as isolated gas production inside the excretory system, secondary to acute bacterial infection. It is a relatively benign entity and needs accurate differentiation from emphysematous pyelonephritis, which is a much morbid condition. It has an excellent prognosis with good response to medical management.
Emphysematous pyelitis is more common in females 2 and is associated with diabetes and urinary tract obstruction.
Symptoms are usually mild, with fever and chills. Sometimes flank tenderness with dysuria is present.
E. coli, Klebsiella, Aerobacter aerogenes and Proteus mirabilis are the commonest causative organisms.
Retroperitoneal gas is seen in many patients. Associated urolithiasis, if any, may also be seen.
May show dirty shadowing in the pelvicalyceal system.
Gas-fluid level in dilated calyx, usually with mild or no obvious features of pyelonephritis.
Treatment and prognosis
Emphysematous pyelitis generally carries a good prognosis and usually responds to intravenous antibiotics followed by oral antibiotics 1.
General considerations include:
- 1. Roy C, Pfleger DD, Tuchmann CM et-al. Emphysematous pyelitis: findings in five patients. Radiology. 2001;218 (3): 647-50. Radiology (full text) - Pubmed citation
- 2. Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics. 28 (1): 255-77. doi:10.1148/rg.281075171 - Pubmed citation