Emphysematous pyelonephritis

Case contributed by Dylan Kurda
Diagnosis certain


Diabetic patient, raised creatinine, fever, and looking "sick".

Patient Data

Age: 75 years
Gender: Male

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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