Emphysematous pyelonephritis and cystitis

Case contributed by Dr Michael P Hartung

Presentation

Abdominal pain, fever.

Patient Data

Age: 65 years
Gender: Male

Extensive parenchymal gas throughout the entire left kidney and most of the right kidney. Small amounts of pneumoretroperitoneum bilaterally. Gas within the left renal vein, IVC, right ventricle, and portal veins. Small ascites. Small locules of gas throughout the bladder wall. Chronic calcific pancreatitis and few small gallstones. 

Case Discussion

Very severe presentation of bilateral emphysematous pyelonephritis and cystitis. Air has extended into the retroperitoneum and systemic and portal veins. The renal involvement is severe and life-threatening, while the bladder involvement only indicates infection by a gas-forming organism (most commonly E. coli) but does not carry a grim prognosis. While emphysematous pyelonephritis is often managed with urgent nephrectomy, medical management was pursued in this case due to the bilateral involvement and poor outcomes expected with bilateral nephrectomies. 

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