Multiple air locules in the left pelvicalyceal system with minimal extension to the upper renal parenchyma and extending down to the upper left ureter and urinary bladder. No parenchymal air pockets or significant perinephric inflammation were evident. These imaging features are suggestive of emphysematous pyelitis versus reflux emphysematous cystitis rather than emphysematous pyelonephritis.
Case courtesy of Dr Aliaa Soliman.