Presentation
Right flank and lower abdominal pain for 2 days. Known diabetic.
Patient Data
Right kidney shows enlargement & altered echogenicity with effacement of sinus fat. There are ill defined hyperechoic areas with poor acoustic shadowing, raising strong suspicion of air in pelvicalyceal system i.e. emphysematous pyelonephritis.
A hyperechoic, 11x12mm, rounded lesion seen at right upper renal pole, is ikely an angiomyolipoma.
Left kidney and urinary bladder are unremarkable.
Urgent CT KUB was suggested for further evaluation.
Enlarged right kidney shows multiple air pockets in pelvicalyceal system, paraplevic location & few foci of air attenuation in renal parenchyma. Reactive inflammatory thickening of renal fascia is seen along with significant peri- & pararenal fat stranding, findings are consistent with emphysematous pyelonephritis
No intrarenal or extrarenal abscess / collection seen.
Tiny hypodense lesion of fat attenuation at upper right renal pole is again identified and is consistent with angiomyolipoma.
Left kidney and visualized part of other abdominal organs are unremarkable,
Free intraluminal air seen in urinary bladder, no intramural foci seen.
Patient was treated vigorously and a follow up CT was done after 15 days.
There is complete resolution of previously seen air attenuation areas in right pelvi-calyceal system. Also noted reduction in peri- & paranephric fat stranding.
No collection or abscess formation seen.
Case Discussion
Ultrasound findings for this patient were highly suspicious for emphysematous pyelonephritis. urgent CT KUB done confirmed the sonograpic findings.
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