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Emphysematous pyelitis

Case contributed by Rania Adel Anan
Diagnosis certain

Presentation

Diabetic patient presented with right flank pain

Patient Data

Age: 55 years
Gender: Female
ct

Gas densities are predominantly noted within the upper and lower calyces of the right kidney. No intraparenchymal or perinephric extension of gas could be identified.​

Bilateral perinephric fat stranding noted.

Gas density forming air fluid level is also there within the full urinary bladder, with no intramural air in urinary bladder wall.

Vascular mural calcifications involving the celiac, superior mesenteric, renal, inferior mesenteric and iliac arteries also noted.

Gallbladder hyperdense stone is noted.

Case Discussion

The CT findings in a diabetic patient with flank pain are consistent 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.

 According to the Huang-Tseng CT classification system, this case can be classified as class 1.

CT is the best diagnostic modality for emphysematous pyelitis/pyelonephritis.

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