Diabetic male presented with hematuria, fever and sepsis. The patient was also found to be in acute renal failure.
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Non contrast CT showing bilateral hydronephrosis, hydroureter and gas in the collecting systems of the right kidney, right ureter and bladder. There is free gas in the right perinephric space and marked perinephric stranding. The bladder is thick walled and catheterized. There is an incidental 42mm left hyperdense renal cyst (85 HU).
Gas in the collecting system and perirenal space which classifies this as 3a according to the Huang-Tseng CT classification system of emphysematous pyelonephritis. The causative organism was found to be Pseudomonas.