Presentation
Right sided abdominal pain, vomiting and fever for 3 days with background of uncontrolled diabetes mellitus
Patient Data
Right kidney is enlarged with heterogeneous enhancement where more than one-third of renal parenchyma is not enhanced adequately. Streaks of gas at the anterior perinephric location of right lower pole. Air pockets are also within the right pelvicalyceal system and right ureter.
Minimal perinephric collection at the right lower pole with marked right perinephric and periureteric fat streakiness. Significant thickening of the right anterior, posterior pararenal fascia and right latero-conal fascia.
Mild degree of right hydronephrosis without hydroureter. No right renal and ureteric calculus.
No evidence of right renal abscess. Multiple enlarged and enhancing abdominal lymph nodes at right renal hilum, paracaval and aortocaval regions. Right renal vein and artery are well opacified.
Ascites at the right anterior pararenal, posterior pararenal spaces, right paracolic gutter and pelvic regions.
Left kidney enhanced homogenously. No left perinephric collection. No left renal parenchymal lesion or calculus. No left hydronephrosis and hydroureter.
Urinary bladder is well distended with diffusely thickened urinary bladder wall. A few air pockets within urinary bladder which can be related to the Foley catheter instrumentation.
Mild right pleural effusion with right basal consolidation.
Case Discussion
Right emphysematous pyelonephritis with extension of gas in the right lower perinephric space and in the right collecting system. More than one-third of the right renal parenchyma is non enhancing. According to Huang-Tseng CT classification system, this is class 3a.
The patient was treated aggressively with broad spectrum intravenous antibiotic and tight control of her blood glucose level.
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