Emphysematous pyelonephritis and pyonephrosis

Case contributed by Dr Ian Bickle

Presentation

Diabetic with sepsis. Source unknown. Ultrasound identified a left sided hydronephrosis.

Patient Data

Age: 55 years
Gender: Female

Left hydronephrosis due to an obstructing ureteric stone.

Additional renal stones.

Perinephric fat stranding and thickening of Gerota's fasica.

Air in the renal cortex and collection system.

Nephrostomy tube insertion for obstructed septic renal tract.

A pyonephrosis was confirmed.

Content of collecting system.

60mls of frank pus aspirated on table.

Case Discussion

Pyonephrosis can be life threatening.  The commonest cause is an obstructed tract secondary to urolithiasis.

Nephrostomy tube insertion is the procedure of choice - essentially synonymous with abscess drainage.

 

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