Presentation
Type 2 diabetes mellitus abdominal pain, nausea and vomiting tenderness LUQ
Patient Data
Large obstructing stones in the left renal pelvis causing hydronephrosis. Delayed enhancement of the left renal parenchyma and perinephric fat stranding indicate obstruction.
There is urothelial enhancement and locules of gas in the collecting system with no history or imaging evidence of instrumentation indicating emphysematous pyonephrosis.
The patient was treated with an emergency nephrostomy as shown on selected fluoroscopy images. This provide acute treatment for pyonephrosis and also access for possible future percutaneous nephrolithotomy (PCNL) of the large volume stone disease.
Case Discussion
A septic obstructed kidney is often a clinical emergency. Emphysematous pyonephrosis is more common in females and 90% have diabetes mellitus. Treatment is with urgent decompression, isolation of an organism and antibiotics +/- supportive care.
According to the Huang-Tseng CT classification system 1 this would be class 1 (gas in the collecting system only).
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