Presentation
Fever and left flank pain with cloudy urine.
Patient Data
Large peripheral rim-enhancing collection was seen in the left kidney with multiple air pockets and fluid density within. Associated with left perinephric fluid and gas collection. A focal defect is seen at the left posterior perinephric fascia with the extension of the collection into the left quadratus lumborum muscle and posterior left abdominal wall muscle. Thickened left anterior and posterior pararenal fascia. Surrounding left perinephric streakiness.
Focal cortical defects are seen at the mid and lower poles of the right kidney. A well-defined hypodense lesion with fat attenuation seen at the upper pole of the right kidney, measuring 0.3 x 0.3 cm (AP x W). This may represent angiomyolipoma.
The left psoas muscle is enlarged compared to the right with minimal surrounding fat streakiness, likely inflammatory or reactive changes.
Reverse attenuation of liver-spleen in keeping with hepatic steatosis.
Mild ascites in the pelvis and left parabolic gutter (not shown in this image).
Case Discussion
Findings of gas and fluid collection within the left kidney, left perinephric, and left perinephric spaces suggest emphysematous pyelonephritis Class 3b according to the Huang-Tseng CT classification system.
Urine culture and sensitivity (C&S) and blood culture and sensitivity (C&S) confirmed Escherichia coli, gram-negative.
The patient has poorly controlled diabetes mellitus, and she was treated with intravenous antibiotics. Ultrasound-guided percutaneous drainage of left emphysematous pyelonephritis was performed.
Emphysematous pyelonephritis carries a high mortality rate with a poor prognosis.
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