Korean J Urogenit Tract Infect Inflamm.  2014 Apr;9(1):50-52. 10.14777/kjutii.2014.9.1.50.

Altered Mentality Patient with Emphysematous Pyelonephritis Disclosed by Abdominal Computed Tomography

• Han SB
• Paik JH
• Jung HM
• Kim JH
• Moon YS

• KMID: 1921577
• DOI: http://doi.org/10.14777/kjutii.2014.9.1.50

Abstract

Emphysematous pyelonephritis is an acute gas forming necrotizing infection of the renal parenchyma with high mortality, which shows non-specific clinical findings. Elderly patients with altered mentality and shock require careful monitoring and abdominal computed tomography scanning is thought to be beneficial in prompt detection of infection focus and management. We report on a patient with altered mentality who showed emphysematous pyelonephritis on abdominal computed tomography and provide a review of the literature.

Keyword

Pyelonephritis; Emphysema; Diagnosis; Tomography scanners, x-ray computed

MeSH Terms

Aged
Diagnosis
Emphysema
Humans
Mortality
Pyelonephritis*
Shock
Tomography Scanners, X-Ray Computed

Figure

• 

  Fig. 1. Chest computed tomography shows an air space consolidation in the bilateral lower lobe of dependant portion.

• 

  Fig. 2. Abdominal computed tomography shows parenchymal destruction and air replacement in the left kidney, air density in the left ureter.

Reference

1. Schultz EH Jr, Klorfein EH. Emphysematous pyelonephritis. J Urol. 1962; 87:762–6.

2. Chen MT, Huang CN, Chou YH, Huang CH, Chiang CP, Liu GC. Percutaneous drainage in the treatment of emphysematous pyelonephritis: 10-year experience. J Urol. 1997; 157:1569–73.

3. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001; 345:1368–77.

4. McDermid KP, Watterson J, van Eeden SF. Emphysematous pyelonephritis: case report and review of the literature. Diabetes Res Clin Pract. 1999; 44:71–5.

5. Shokeir AA, El-Azab M, Mohsen T, El-Diasty T. Emphysematous pyelonephritis: a 15-year experience with 20 cases. Urology. 1997; 49:343–6.

6. Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicora-diological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000; 160:797–805.

7. Wan YL, Lee TY, Bullard MJ, Tsai CC. Acute gas-producing bacterial renal infection: correlation between imaging findings and clinical outcome. Radiology. 1996; 198:433–8.

8. Pontin AR, Barnes RD. Current management of emphysematous pyelonephritis. Nat Rev Urol. 2009; 6:272–9.