Emphysematous pyelitis

Case contributed by Dr Safwat Mohammad Almoghazy

Presentation

Left loin pain with fever and elevated creatinine and leukocytosis, for CT KUB to rule out obstructive uropathy.

Patient Data

Age: 45 years
Gender: Female

CT KUB

CT

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.

CT KUB after 15 days

CT

Comparing with the previous study done before, the current study shows; The left-sided double J stent is noted in situ. Still swollen and edematous left kidney. Total resolution of the previously noted multiple gas pockets seen within the collecting system as well as the upper cortical parenchyma.

Case Discussion

A 45-year-old woman presented to our hospital complaining of fever, leukocytosis, elevated serum creatinine and requested CT KUB.

CT KUB was performed and shows features suggestive of emphysematous pyelitis or reflux emphysematous cystitis rather than emphysematous pyelonephritis.

The patient responded poorly to antibiotics alone then the double J stent was inserted with a continuous antibiotic. CT KUB examination was then performed and showed a persistently swollen and edematous left kidney and total resolution of the previously noted multiple gas pockets seen within the collecting system as well as the upper cortical parenchyma.

Huang and Tseng defined four classes of emphysematous pyelonephritis; our patient had class 1 emphysematous pyelonephritis (so-called emphysematous pyelitis), which is a milder form with a better prognosis.

Emphysematous pyelitis is a term representing gas-forming urinary tract infection that is associated with gas localized in only the renal collecting system. 

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