Presentation
Diabetic patient, raised creatinine, fever, and looking "sick".
Patient Data
Age: 75 years
Gender: Male
From the case:
Emphysematous pyelonephritis
Axial non-contrast
Extensive, bilateral, streaks and loculated gas, involving both renal parenchyma, pelvicalyceal system, proximal ureter and perirenal space.
Evidence of renal parenchymal destruction on both sides and extensive perirenal fat stranding.
Features are those of severe bilateral emphysematous pyelonephritis.
Free fluid is noted in the pararenal spaces as well as pelvis.
Case Discussion
CT features of emphysematous pyelonephritis differentiates into two types
-
type 1 -
- renal parenchymal destruction with streaky or mottled appearance of gas.
- intra- or extrarenal fluid collections are characteristically absent.
- it is usually more aggressive and lead to death shortly, if not intervened early.
- type 2 - renal or extrarenal collections associated with bubbly or loculated gas, or gas within pelvicalyceal system or ureter.
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