Emphysematous pyelitis

Case contributed by Zeyad Metwalli
Diagnosis certain


Two-week history of gross hematuria.

Patient Data

Age: 55 years
Gender: Male

Coronal reconstruction of non-contrast CT reveals a large stone in the inferior left renal pelvis. Several foci of air are noted throughout the left renal calyces. No intraparenchymal air is identified.​

Case Discussion

Foci of air which conform to the renal calyces in this diabetic patient with hematuria is compatible with emphysematous pyelitis. The lack of intraparenchymal air distinguishes this entity from emphysematous pyelonephritis, which carries a more grave prognosis and often requires surgical management. Calculi have been reported in association with emphysematous pyelitis as is seen in this patient. 

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