Two-week history of gross hematuria.
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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.
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.