Emphysematous pyelonephritis

Case contributed by Dr Prashant Mudgal


Elderly lady presented with left renal angle and fever with chills.

Patient Data

Age: 65 years
Gender: Female

Air attenuation foci within the renal parenchyma of superior pole of left kidney along with a thick walled, peripherally enhancing multiloculated collection of air with fluid level and surrounding fat stranding measuring 13.7(CC) x7.1(Tr) x4.9(AP) cm noted in the retrorenal space and postererior pararenal space in continuation with the renal parenchyma of superior pole and extending till the left dome of diaphragm. There is associated reactive subpleural basal consolidation and minimal pleural effusion on the left side Imaging findings are suggestive of emphysematous pyelonephritis with retroperitoneal abscess.

The rest of the renal perenchyma and contralateral kidney shows normal enhancement.

There are multiple enlarged non necrotic lymph nodes noted in the left perinephric and para aortic retroperitoneum, the largest node measures approximately 18x10 mm.

Calculus measuring 6.2 mm in the lower pole of left kidney.

Both kidneys shows good concentration and excretion of contrast suggests normal renal function.

The left adrenal is abutted and displaced superiorly by the abscess however, both adrenal glands are normal.

Case Discussion

Emphysematous pyelonephritis is a life threatening form of infective pyelonephritis most commonly seen in diabetic elderly individuals. However, immunocompromised people are also prone to such infections.

Early diagnosis and treatment is the key to survival. CT scan is a sensitive as well as specific modality for diagnosis.

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