eMedicine Specialties > Radiology > Genitourinary

Emphysematous Pyelonephritis: Multimedia

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Coauthor(s): Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Colm Boylan, MRCP, FRCR, Specialist Registrar, Department of Radiology, North Manchester General Hospital NHS Trust, UK; Brendan Costello, MD, Clinical Director, Department of Urology, North Manchester General Hospital; Khalid Mahmood, MBBS, FCPS, Locum Appointment Training Specialist Registrar, Department of Radiology - Paediatric, Royal Liverpool (Alder Hey) Children's Hospital
Contributor Information and Disclosures

Updated: Jan 25, 2008

Multimedia

(Enlarge Image)

Media file 1: In a 58-year-old woman with diabetes, emergency intravenous pyelography (IVP) had been requested for an evaluation of flank pain. After this scout image was obtained, a lateral radiograph (see Image 2) was obtained, and the IVP was canceled and CT (see Images 3-4) was performed. This anteroposterior (AP) scout image shows striated intrarenal gas (within medullary rays) and perinephric gas.

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In a 58-year-old woman with diabetes, emergency intravenous pyelography (IVP) had been requested for an evaluation of flank pain. After this scout image was obtained, a lateral radiograph (see Image 2) was obtained, and the IVP was canceled and CT (see Images 3-4) was performed. This anteroposterior (AP) scout image shows striated intrarenal gas (within medullary rays) and perinephric gas.

(Enlarge Image)

Media file 2: The lateral image confirms that the gas is present within the kidney, overlying the spine (same patient as in Images 1, 3, and 4).

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The lateral image confirms that the gas is present within the kidney, overlying the spine (same patient as in Images 1, 3, and 4).

(Enlarge Image)

Media file 3: CT scan depicts the intrarenal gas very well. The contralateral kidney looks normal (same patient as in Images 1, 2, and 4).

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CT scan depicts the intrarenal gas very well. The contralateral kidney looks normal (same patient as in Images 1, 2, and 4).

(Enlarge Image)

Media file 4: Magnified CT obtained with a lung window setting better reveals the striated intrarenal gas and subcapsular gas in the posterior aspect (same patient as in Images 1-3).

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Magnified CT obtained with a lung window setting better reveals the striated intrarenal gas and subcapsular gas in the posterior aspect (same patient as in Images 1-3).

(Enlarge Image)

Media file 5: Sonogram of the right kidney in a 52-year-old woman demonstrates echogenic gas within the collecting system and posterior cortex of the right kidney. The involvement of the posterior cortex is partly obscured by shadowing from the gas in the collecting system.

[ CLOSE WINDOW ]

Sonogram of the right kidney in a 52-year-old woman demonstrates echogenic gas within the collecting system and posterior cortex of the right kidney. The involvement of the posterior cortex is partly obscured by shadowing from the gas in the collecting system.

(Enlarge Image)

Media file 6: CT scan through the top of the right kidney in a 52-year-old woman (same patient as in Images 5, 7, and 8) with emphysematous pyelonephritis. Gas is present in the upper pole cortex of the kidney. Note normal excretion of contrast material in the left kidney.

[ CLOSE WINDOW ]

CT scan through the top of the right kidney in a 52-year-old woman (same patient as in Images 5, 7, and 8) with emphysematous pyelonephritis. Gas is present in the upper pole cortex of the kidney. Note normal excretion of contrast material in the left kidney.

(Enlarge Image)

Media file 7: CT scan through the middle of the right kidney in a 52-year-old woman (same patient as in Images 5, 6, and 8) with emphysematous pyelonephritis. Gas is present in the cortex and collecting system of the kidney, with some extension into the perinephric space.

[ CLOSE WINDOW ]

CT scan through the middle of the right kidney in a 52-year-old woman (same patient as in Images 5, 6, and 8) with emphysematous pyelonephritis. Gas is present in the cortex and collecting system of the kidney, with some extension into the perinephric space.

(Enlarge Image)

Media file 8: CT scan through the lower portion of the right kidney in a 52-year-old woman (same patient as in Images 5-7) with emphysematous pyelonephritis. Gas is present in the collecting system and anterior cortex of the kidney.

[ CLOSE WINDOW ]

CT scan through the lower portion of the right kidney in a 52-year-old woman (same patient as in Images 5-7) with emphysematous pyelonephritis. Gas is present in the collecting system and anterior cortex of the kidney.

(Enlarge Image)

Media file 9: Axial contrast-enhanced CT scans showing gas within the renal collecting system and the urinary bladder following bladder urologic intervention (Images 9-11)

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Axial contrast-enhanced CT scans showing gas within the renal collecting system and the urinary bladder following bladder urologic intervention (Images 9-11)

(Enlarge Image)

Media file 10: Axial contrast-enhanced CT scans showing gas within the renal collecting system and the urinary bladder following bladder urologic intervention (Images 9-11)

[ CLOSE WINDOW ]

Axial contrast-enhanced CT scans showing gas within the renal collecting system and the urinary bladder following bladder urologic intervention (Images 9-11)

(Enlarge Image)

Media file 11: Axial contrast-enhanced CT scans showing gas within the renal collecting system and the urinary bladder following bladder urologic intervention (Images 9-11)

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Axial contrast-enhanced CT scans showing gas within the renal collecting system and the urinary bladder following bladder urologic intervention (Images 9-11)

More on Emphysematous Pyelonephritis

Overview: Emphysematous Pyelonephritis

Imaging: Emphysematous Pyelonephritis

Follow-up: Emphysematous Pyelonephritis

Multimedia: Emphysematous Pyelonephritis

References

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References

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Jain SK, Agarwal N, Chaturvedi SK. Emphysematous pyelonephritis: a rare presentation. J Postgrad Med. Jan-Mar 2000;46(1):31-2. [Medline].
Roy C, Pfleger DD, Tuchmann CM, et al. Emphysematous pyelitis: findings in five patients. Radiology. Mar 2001;218(3):647-50. [Medline].
Sathyanathan VP, Gomathy S, Potty RN, et al. Emphysematous pyelonephritis. J Assoc Physicians India. Jun 1998;46(6):562-3. [Medline].
Shokeir AA, El-Azab M, Mohsen T, El-Diasty T. Emphysematous pyelonephritis: a 15-year experience with 20 cases. Urology. Mar 1997;49(3):343-6. [Medline].
Falagas ME, Alexiou VG, Giannopoulou KP, Siempos II. Risk factors for mortality in patients with emphysematous pyelonephritis: a meta-analysis. J Urol. Sep 2007;178(3 Pt 1):880-5; quiz 1129. [Medline].
Ronald A, Ludwig E. Urinary tract infections in adults with diabetes. Int J Antimicrob Agents. Apr 2001;17(4):287-92. [Medline].
Tang HJ, Li CM, Yen MY, et al. Clinical characteristics of emphysematous pyelonephritis. J Microbiol Immunol Infect. Jun 2001;34(2):125-30. [Medline].
Dahnart W. Radiology Review Manual. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2007.
Komura S, Shindoh N, Minowa O, et al. Emphysematous pyelonephritis- conversion of type i to type II appearance on serial CT studies. Clin Imaging. Nov-Dec 1999;23(6):386-8. [Medline].
Wan YL, Lee TY, Bullard MJ, Tsai CC. Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome. Radiology. Feb 1996;198(2):433-8. [Medline].
Best CD, Terris MK, Tacker JR, Reese JH. Clinical and radiological findings in patients with gas forming renal abscess treated conservatively. J Urol. Oct 1999;162(4):1273-6. [Medline].
Grozel F, Berthezene Y, Guerin C, et al. Bilateral emphysematous pyelonephritis resolving to medical therapy: demonstration by US and CT. Eur Radiol. 1997;7(6):844-6. [Medline].
Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med. Mar 27 2000;160(6):797-805. [Medline].
Kuo YT, Chen MT, Liu GC, et al. Emphysematous pyelonephritis: imaging diagnosis and follow-up. Kaohsiung J Med Sci. Mar 1999;15(3):159-70. [Medline].
Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review. Radiographics. Jan-Feb 2008;28(1):255-77; quiz 327-8. [Medline].
Punekar SV, Kinne JS, Rao SR, et al. Xanthogranulomatous pyelonephritis presenting as emphysematous pyelonephritis: a rare association. J Postgrad Med. Oct-Dec 1999;45(4):125. [Medline].
Singh I, Pachisia SS, Kumar S, Arora VK, Kumar P. Emphysematous pyelonephritis: a consequence of adenocarcinoma of urinary bladder in a nondiabetic patient. J Postgrad Med. Oct-Dec 2005;51(4):324-5. [Medline].
Portnoy O, Apter S, Koukoui O, Konen E, Amitai MM, Sella T. Gas in the kidney: CT findings. Emerg Radiol. Jun 2007;14(2):83-7. [Medline].
Chen MT, Huang CN, Chou YH, et al. Percutaneous drainage in the treatment of emphysematous pyelonephritis: 10-year experience. J Urol. May 1997;157(5):1569-73. [Medline].
Roberts JA. Management of pyelonephritis and upper urinary tract infections. Urol Clin North Am. Nov 1999;26(4):753-63. [Medline].
Chan PH, Kho VK, Lai SK, Yang CH, Chang HC, Chiu B. Treatment of emphysematous pyelonephritis with broad-spectrum antibacterials and percutaneous renal drainage: an analysis of 10 patients. J Chin Med Assoc. Jan 2005;68(1):29-32. [Medline].

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Keywords

EPN, upper urinary tract infection, renal tract infections with intraparenchymal renal gas, emphysematous pyelitis, perinephric emphysema, urinary tract infection, gas in the kidney, renal gas, Escherichia coli, E coli, Klebsiella pneumoniae, K pneumoniae, Proteus mirabilis, P mirabilis

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Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP is a member of the following medical societies: American Institute of Ultrasound in Medicine, Radiological Society of North America, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Colm Boylan, MRCP, FRCR, Specialist Registrar, Department of Radiology, North Manchester General Hospital NHS Trust, UK
Colm Boylan, MRCP, FRCR is a member of the following medical societies: Royal College of Radiologists
Disclosure: Nothing to disclose.

Brendan Costello, MD, Clinical Director, Department of Urology, North Manchester General Hospital
Brendan Costello, MD is a member of the following medical societies: British Medical Association
Disclosure: Nothing to disclose.

Khalid Mahmood, MBBS, FCPS, Locum Appointment Training Specialist Registrar, Department of Radiology - Paediatric, Royal Liverpool (Alder Hey) Children's Hospital
Disclosure: Nothing to disclose.

Medical Editor

Steven Perlmutter, MD, FACR, Clinical Associate Professor, Radiology Residency Program Director, Radiology Medical Director, Department of Radiology, University Hospital at Stony Brook
Steven Perlmutter, MD, FACR is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, American Medical Association, American Roentgen Ray Society, Association of Program Directors in Radiology, Association of University Radiologists, Medical Society of the State of New York, Radiological Society of North America, Society of Breast Imaging, Society of Nuclear Medicine, and Society of Uroradiology
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Arnold C Friedman, MD, FACR, Associate Chairman, Department of Radiology, University of Florida Health Science Center; Chief, Department of Radiology, Shands-Jacksonville Hospital
Arnold C Friedman, MD, FACR is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Staff, Department of Radiology, Virginia Mason Medical Center
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

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eMedicine Specialties > Radiology > Genitourinary

Emphysematous Pyelonephritis: Multimedia

Multimedia

The lateral image confirms that the gas is present within the kidney, overlying the spine (same patient as in Images 1, 3, and 4).

CT scan depicts the intrarenal gas very well. The contralateral kidney looks normal (same patient as in Images 1, 2, and 4).

Magnified CT obtained with a lung window setting better reveals the striated intrarenal gas and subcapsular gas in the posterior aspect (same patient as in Images 1-3).

Sonogram of the right kidney in a 52-year-old woman demonstrates echogenic gas within the collecting system and posterior cortex of the right kidney. The involvement of the posterior cortex is partly obscured by shadowing from the gas in the collecting system.

CT scan through the top of the right kidney in a 52-year-old woman (same patient as in Images 5, 7, and 8) with emphysematous pyelonephritis. Gas is present in the upper pole cortex of the kidney. Note normal excretion of contrast material in the left kidney.

CT scan through the middle of the right kidney in a 52-year-old woman (same patient as in Images 5, 6, and 8) with emphysematous pyelonephritis. Gas is present in the cortex and collecting system of the kidney, with some extension into the perinephric space.

CT scan through the lower portion of the right kidney in a 52-year-old woman (same patient as in Images 5-7) with emphysematous pyelonephritis. Gas is present in the collecting system and anterior cortex of the kidney.

Axial contrast-enhanced CT scans showing gas within the renal collecting system and the urinary bladder following bladder urologic intervention (Images 9-11)

Axial contrast-enhanced CT scans showing gas within the renal collecting system and the urinary bladder following bladder urologic intervention (Images 9-11)

Axial contrast-enhanced CT scans showing gas within the renal collecting system and the urinary bladder following bladder urologic intervention (Images 9-11)

More on Emphysematous Pyelonephritis

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor