Emphysematous pyelonephritis - renal graft
Patient with a history of end-stage renal disease secondary to ADPKD, who underwent a kidney transplant in the right iliac fossa. An early thrombosis of the graft was diagnosed by Doppler US and CT. Transplantectomy was postponed because of a clinically diagnosed prostatitis. 2 weeks later presents fever and pelvic pain, with blood tests showing leukopenia and anemia. A CT scan was performed.
Abdomen and pelvis
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Portal-venous phase CT scan shows enlarged native kidneys in a patient with ADPKD. Right iliac fossa graft shows no vascularization in relation to previously known arterial and venous thrombosis (with a small part of the renal artery of the graft filled with contrast). There is air in the excretory system of the transplant and a perirenal fluid collection with air and enhancing walls. The findings were reported as a perirenal abscess, possibly secondary to emphysematous pyelonephritis of the renal graft.
Because of the CT findings percutaneous drainage was performed, obtaining 100cc of purulent fluid consistent with the suspicion of a perirenal abscess.
Emphysematous pyelonephritis is an uncommon severe infection of the kidney, usually seen in diabetic but also immunocompromised patients. In this case, there was leukopenia and the patient was still undergoing immunosuppressive therapy because of the transplant. If left untreated, it carries a high risk of sepsis and death.