CLINICAL HISTORTY:

• Fever with chills and tiredness.
• History of Right kidney DJ stenting for pyelonephritis; DJ stent removed on 29.03.2023.

IMAGING FINDING:

Fig: shows bulky with air pocket with hypodense lesion

CT FINDINGS:

Right kidney appears diffusely enlarged in size 

• A large hypodense (average HU +24) lesion measuring about 8.9 x 7.6 cm in its maximum dimension noted in the interpolarregion kidney extending to perinephric space.
• Few air loculi noted in the mid pole calyces.
• Adjacent diffuse perinephric fat stranding with thickening of the pararenal fascia.

Fig: shows​ mildly bulky left kidney with air loculi  involving all the calyces. Mild perinephric fat stranding with thickening of the pararenal fascia.

Fig: Air fluid level noted within the urinary bladder with no evidence of intramural gas/ perivesical fat stranding.

ANSWER:

Emphysematous pyelonephritis is an acute severe necrotizing infection of renal parenchyma and its surrounding tissues that results in presence of gas in the renal parenchyma, collecting system or perinephric tissue.

DISCUSSION:

Emphysematous pyelonephritis (EPN) is a severe, life-threatening infection of the kidney that is characterized by the presence of gas within the renal parenchyma and/or collecting system. It typically occurs in individuals with poorly controlled diabetes, urinary tract obstruction, or other immunocompromising conditions.

EPN is considered a medical emergency, and immediate treatment is necessary to prevent serious complications such as sepsis, renal failure, and death. Treatment typically involves a combination of antibiotics, aggressive fluid resuscitation, and sometimes surgical intervention.

Dr Kanagasabai
Consultant Radiologist