8 year history of diabetes mellitus, uncontrolled for 6 months. Now with flank pain, continuous fever and dysuria for the past 1 week.
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NCCT showing left renal enlargement with architectural distortion. There is bubbly and linear streaks of air within renal parenchyma and perinephric space with intra renal fluid collection. Bilateral perinephric fat stranding and thickening of gerota fascia noted (more in left kidney)
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The non-contrast CT findings in this diabetic patients with history of fever, flank pain, leucocytosis, thrombocytopenia accurately diagnose Emphysematous pyelonephritis. It falls into type 2 emphysematous pyelonephritis according to the classification by Wan etal. Non-contrast CT was performed due to poor renal function (high serum urea and creatinine).
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