J Korean Soc Radiol.  2015 Sep;73(3):204-208. 10.3348/jksr.2015.73.3.204.

Emphysematous Pyelonephritis: A Rare Life-Threatening Complication after Extracorporeal Shock Wave Lithotripsy

• Kim SH
• Chung DJ
• Yeo DM
• Sonh DW
• Hahn ST

• KMID: 2043614
• DOI: http://doi.org/10.3348/jksr.2015.73.3.204

Abstract

Emphysematous pyelonephritis (EPN), caused by extracorporeal shock wave lithotripsy (ESWL), has not been reported in the literature; and the mechanism of this disease is unknown. Although many studies have conjectured about the various causes of EPN, ESWL was not one of them. The patient in this report was a 65-year-old woman with a past medical history of diabetes; the patient underwent an ESWL that caused the EPN. To the best of our knowledge, this is the first report of an EPN case that was caused by ESWL.

MeSH Terms

Aged
Female
Humans
Kidney
Lithotripsy*
Pyelonephritis*
Shock*
Urolithiasis

Figure

• 

  Fig. 1 Emphysematous nephritis after extracorporeal shock wave lithotripsy (ESWL) in a 65-year-old woman. A. About 7 mm sized stone in the left proximal ureter on abdominal CT (arrow) performed before ESWL. B. Left kidney was swollen with hydronephrosis and perinephric fat infiltration.

• 

  Fig. 2 Non-enhanced computed tomography scan of the abdomen post-extracorporeal shock wave lithotripsy. A. Gas replacing the destroyed left kidney parenchyma (arrows) and gas in the perinephric space (arrowheads). B. Remaining stone in left proximal ureter (arrow).

• 

  Fig. 3 Emphysematous nephritis after extracorporeal shock wave lithotripsy in a 65-year-old woman. A. Photograph of resected specimen shows subcapsular emphysema, necrosis and hemorrhage in the parenchyma. B. Photomicrograph of histologic specimen shows coagulative necrosis (arrow) in kidney tissue (hematoxylin and eosin stain, × 100).

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