Different Imaging Modalities for Evaluating Emphysematous Pyelonephritis (EPN); a Life Threatening Urological Emergency – A case report

<p>Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the renal parenchyma; it causes gas formation within the collecting system, renal parenchyma, and/or perirenal tissues. In this reported case, a female patient of 40 years was admitted in a tertiary hospital with history of severe left flank pain, lower abdominal pain, fever, vomiting and scanty micturition for three days. Ultrasonogram showed-normal right kidney but left renal bed reveals extensive air obscuring visualization of left kidney with probe tenderness in left flank. Contrast CT scan of KUB shows larger left kidney with extensive air (CT number = -1000 HU) within the renal parenchyma, collecting systems and perinephric space. This case was diagnosed as EPN. After conservative treatment patient was improved significantly.</p><p>Bangladesh J. Nuclear Med. 20(1): 63-66, January 2017</p>

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MO650EMPHYSEMATOUS PYELONEPHRITIS IN TYPE 2 DIABETES – CLINICAL PROFILE AND MANAGEMENT

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab094.0018 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Dr Sanjay Bhat ◽

Anupma Kaul ◽

Priyanka Rai ◽

Rohit Srivastav

Keyword(s):

Glycosylated Hemoglobin ◽

Left Kidney ◽

Diabetic Patients ◽

Emphysematous Pyelonephritis ◽

Medical College ◽

Poor Outcome ◽

Microbial Profile ◽

Disturbance Of Consciousness ◽

Life Threatening ◽

High Index Of Suspicion

Abstract Background and Aims Emphysematous pyelonephritis (EPN) is a rare but life-threatening acute suppurative infection of the kidney among diabetics. There is no current consensus on management of EPN. Method A prospective observational study was conducted at Department of General Surgery at RML institute of Medical sciences , Lucknow as well as at Eras Lucknow medical college, Lucknow from 2015-2018 to look for clinical, microbial profile and treatment outcome of diabetic patients with emphysematous pyelonephritis. Results A total of 76 Diabetic patients diagnosed with pyelonephritis were identified, of which 15 patients were diagnosed with EPN (26.3%). The mean age of the patients was 58.4±6.5 years. Mean duration of diabetes was 5.3 ± 3.3 years. 12 (82%) of the 15 patients with DM had a glycosylated hemoglobin A1C level higher than 7.5. Renal dysfunction at presentation was seen in 11 (73.3%) patients. Among the unilateral involvement, left kidney was more affected. Escherichia coli in 11 (73.3%), Klebsiella sp. in 1 (6.6%), Pseudomonas in 1 (6.6%), and 1 each with polymicrobial and fungal UTI respectively. Of 15 EPN patients, 13 (86.6 %) survived and 1 (6.6 %) expired. 2 of them underwent nephrectomy both survived. All patients with Stage I, II and IIIa EPN (n = 12) were managed with antibiotics with or without PCD. In EPN Stage IIIb/IV (n = 3), all the 3 (20 %) patients were managed with antibiotics and PCD and later 2 (13.3%) needed nephrectomy. Only time to diagnosis, altered sensorium, shock at presentation and thrombocytopenia were associated with poor outcome in EPN patients (P < 0.05) Multiple logistic regression tests showed shock (P = .04) and and disturbance of consciousness (P = .05) on hospital admission as being the independent factors for poor outcome. Conclusion EPN in diabetics needs high index of suspicion, timely diagnosis and good multidisciplinary approach with adequate antibiotics and surgical management for better patient outcomes.

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Emphysematous Pyelonephritis Presenting as Pneumaturia and the Use of Point-of-Care Ultrasound in the Emergency Department

Case Reports in Emergency Medicine ◽

10.1155/2019/6903193 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Natasha Brown ◽

Paul Petersen ◽

David Kinas ◽

Mark Newberry

Keyword(s):

Emergency Department ◽

Point Of Care ◽

Left Kidney ◽

Severe Infection ◽

Renal Parenchyma ◽

Surrounding Tissue ◽

Dependent Diabetes Mellitus ◽

Point Of Care Ultrasound ◽

Emphysematous Pyelonephritis ◽

Collecting System

Emphysematous pyelonephritis (EPN) is a rare form of pyelonephritis causing a severe infection of the renal system that includes gas in the renal parenchyma, collecting system and surrounding tissue often presenting with sepsis. We report the case of a 60-year-old male with poorly controlled insulin dependent diabetes mellitus who presented with abdominal pain, nausea, vomiting, and “peeing air.” CT scan revealed air extending from the left renal parenchyma, perinephric fat and into the bladder, consistent with emphysematous pyelonephritis. Bedside point-of-care ultrasound (POCUS) subsequently revealed dirty shadowing and reverberation artifacts in the left kidney and the bladder consistent with gas in the urinary collecting system. By understanding the identifying artifacts seen with EPN, reflective shadow and reverberation artifact, the emergency physician may be alerted to the diagnosis sooner. Often this illness presents similarly to simple, acute pyelonephritis or undifferentiated sepsis. Therefore, POCUS allows for real time consideration of this condition while in the emergency department and thus prompter time to treatment.

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The Evaluation of Biochemical and Microbiological Parameters in the Diagnosis of Emphysematous Pyelonephritis

Revista de Chimie ◽

10.37358/rc.17.6.5658 ◽

2017 ◽

Vol 68 (6) ◽

pp. 1285-1288

Author(s):

Nicolae Grigore ◽

Valentin Pirvut ◽

Maria Totan ◽

Dan Bratu ◽

Sebastian Ioan Cernusca Mitariu ◽

...

Keyword(s):

Biochemical Parameters ◽

Biochemical Analysis ◽

Renal Parenchyma ◽

Diabetic Patients ◽

First Line ◽

Emphysematous Pyelonephritis ◽

Gram Negative ◽

Microbiological Parameters ◽

Life Threatening ◽

Etiologic Diagnosis

Emphysematous pyelonephritis (EPN) is a severe, necrotizing infection of the renal parenchyma, produced by gas-forming Gram-negative bacilli. Even though only few cases are reported in the literature, the disease is not so rare and can become life-threatening if the diagnose is not quick and the therapeutic messures efficient. The biochemical analysis are the first line diagnostic, indicating the severity of the infection. The aim of our study was to to evaluate the importance of biochemical parameters, as first line diagnosis and also of the microbiological parameters, as etiologic diagnosis, in severe renal infections produced by gas forming bacili mainly in diabetic patients, predominantly women, with obstructive nephrolithiasis.

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Emphysematous pyelonephritis with complete duplication of the left urinary tract

Canadian Urological Association Journal ◽

10.5489/cuaj.740 ◽

2013 ◽

Vol 5 (6) ◽

pp. 101

Author(s):

Yasuto Yamasaki ◽

Shigehiko Koga ◽

Yuzo Minami ◽

Hideki Sakai

Keyword(s):

Urinary Tract ◽

Japanese Literature ◽

Flank Pain ◽

High Grade ◽

High Grade Fever ◽

Emphysematous Pyelonephritis ◽

Left Flank ◽

Life Threatening ◽

Complete Duplication ◽

Left Flank Pain

Emphysematous pyelonephritis (EPN) is a life-threatening bacterialinfection and should be treated rapidly and carefully. We reporta case of EPN with complete duplication of the left urinary tract.A 68-year-old woman was admitted to our hospital complainingof high-grade fever and left flank pain. An abdominal computedtomography scan showed gas was presented in the renal parenchyma,not only the pelvis and ureter. Based on these findings,a diagnosis of left EPN was made. A partial nephrectomy of theaffected left upper pole moiety was performed and the patientunderwent additional medical management. Other 83 cases ofEPN from the Japanese literature were reviewed.

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Covid-modulated emphysematous pyelonephritis against the background of a severe course of oxygen-dependent Covid pneumonia

Radiation Diagnostics, Radiation Therapy ◽

10.37336/2707-0700-2021-1-5 ◽

2021 ◽

Vol 12 (1) ◽

pp. 49-54

Author(s):

A. Mukhomor ◽

A. Zhelezko

Keyword(s):

Carbon Dioxide ◽

Clinical Observation ◽

Left Kidney ◽

Gas Bubbles ◽

Renal Parenchyma ◽

Urinary System ◽

Rare Form ◽

Emphysematous Pyelonephritis ◽

Acute Necrotizing

EP is a rare form of acute purulent pyelonephritis caused by microorganisms that decompose glucose into acid and carbon dioxide, characterized by the development of an acute necrotizing process in the renal parenchyma. The disease is characterized by the accumulation of gas bubbles in the kidney tissues (in the kidney interstitium, its cavity or urinary system) and in the surrounding fiber. The disease is characterized by the accumulation of gas bubbles in the kidney tissues (in the kidney interstitium, its cavity or urinary system) and in the surrounding fiber. A clinical observation of a 66-year-old patient with emphysematous pyelonephritis of the left kidney, initiated by oxygen-dependent severe Covid pneumonia, is described. The comments indicate the possible pathogenesis of the pathology and the role of polymorbidity.

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Emphysematous pyelonephritis in an infant from Sokoto, north-western Nigeria

African Journal of Laboratory Medicine ◽

10.4102/ajlm.v10i1.1181 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Fatima B. Jiya ◽

Paul K. Ibitoye ◽

Nma M. Jiya ◽

Maryam Amodu-Sanni ◽

Yahaya Mohammed ◽

...

Keyword(s):

Abdominal Mass ◽

Male Infant ◽

University Teaching ◽

Emphysematous Pyelonephritis ◽

Left Flank ◽

Paediatric Unit ◽

Life Threatening ◽

History Of ◽

Excessive Crying ◽

North Western

Introduction: Emphysematous pyelonephritis is a life-threatening necrotising bacterial infection of the kidneys. It is rare among children and can be fatal if not promptly identified and treated.Case presentation: A 7-month-old male infant presented to the Emergency Paediatric Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, on 12 November 2019 with a 5-day history of fever and vomiting, and a 3-day history of a progressively enlarging, left-side abdominal mass. There was associated excessive crying on micturition, refusal to feed and weight loss. He looked ill and was in respiratory distress, irritable, febrile (38.8 °C), moderately dehydrated and pale. His weight and length were 5.5 kg and 64 cm. He had a tender, firm and ballotable abdominal mass on the left flank measuring 8 cm × 10 cm. His pulse rate was 140 beats/min, blood pressure 60/40 millimetres of mercury and respiratory rate was 65 cycles/min. He had widespread coarse crepitations and normal heart sounds on chest auscultation.Management and outcome: An initial diagnosis of sepsis was made. Other considerations were nephroblastoma and neuroblastoma. Ceftriaxone and blood transfusion were commenced with subsequent administration of intravenous fluids. Further radiologic investigations revealed emphysematous pyelonephritis. The patient had percutaneous drainage and extended spectrum β-lactamase-producing Escherichia coli (sensitive to meropenem) which was isolated from the aspirate culture after 48 h of incubation. Meropenem could not be commenced because of non-availability and high cost. The patient subsequently deteriorated and died from septic shock.Conclusion: Emphysematous pyelonephritis has a fulminant course when not diagnosed promptly and treated adequately.

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Emphysematous pyelonephritis: non surgical treatment approach

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v14i3.17753 ◽

2015 ◽

Vol 14 (3) ◽

pp. 305-307

Author(s):

Kiran Kumar Singal ◽

Neerja Singal ◽

Bhaskar Gupta ◽

Karun Puran Bhatti ◽

Abhinav Gupta

Keyword(s):

Diabetes Mellitus ◽

Left Kidney ◽

Medical Science ◽

Severe Infection ◽

Lumbar Region ◽

Emphysematous Pyelonephritis ◽

Patients With Diabetes ◽

Life Threatening ◽

High Doses

Emphysematous pyelonephritis is a severe infection characterized by the presence of gas within the renal parenchyma tissues. It is a life threatening complication of bacterial interstitial nephritis, and it mainly occurs in patients with diabetes mellitus. We report a case of a 37 year old female who complained of fever and pain in left lumbar region on admission. Her past medical history included uncontrolled type 2 diabetes mellitus. On USG (ultrasonography), left kidney swollen and show echogenic linear specs with dirty shadowing suggestive of air in pelvicalyceal system (PCS). She was treated with intensive antibiotic therapy in high doses. On repeat USG there was marked reduction in air shadow in kidney and patient improved clinically.Bangladesh Journal of Medical Science Vol.14(3) 2015 p.305-307

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Emphysematous pyelonephritis: A rare cause of sepsis in hepatocellular carcinoma

Proceedings of Singapore Healthcare ◽

10.1177/2010105821992805 ◽

2021 ◽

pp. 201010582199280

Author(s):

Hany Haqimi Wan Hanafi ◽

Nazri Mustaffa ◽

Yeong Yeh Lee ◽

Siti Nurbaya Mohd Nawi

Keyword(s):

Diabetes Mellitus ◽

Computed Tomography ◽

Hepatocellular Carcinoma ◽

Liver Disease ◽

Chronic Liver Disease ◽

Surgical Intervention ◽

Computed Tomography Scan ◽

Emphysematous Pyelonephritis ◽

Urological Emergency ◽

Tomography Scan

The association between emphysematous pyelonephritis (EPN) and diabetes mellitus is well known. EPN as the cause of sepsis in hepatocellular carcinoma (HCC) is rare and unreported. We report a case of EPN in a non-diabetic HCC patient, in which the clinical features of decompensated chronic liver disease masked the more sinister urological emergency to a certain degree. A computed tomography scan of the abdomen revealed a mixture of gas and fluid in the left retrorenal space, in keeping with left EPN. Nevertheless, the course of clinical deterioration was rather rapid that any surgical intervention was not feasible.

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Thrombophlebitis of the Right Renal Capsular Vein during the Early Postpartum Period

Case Reports in Obstetrics and Gynecology ◽

10.1155/2018/3096468 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Koji Nakamura ◽

Kensuke Nakanishi ◽

Satoshi Kubota ◽

Ryoko Takahashi ◽

Mari Tomiie ◽

...

Keyword(s):

Abdominal Pain ◽

Postpartum Period ◽

Anticoagulation Therapy ◽

Lower Abdominal Pain ◽

Postpartum Woman ◽

Ovarian Vein ◽

Early Postpartum Period ◽

Early Postpartum ◽

The Right ◽

Contrast Ct

Venous thrombophlebitis is an uncommon cause of fever and lower abdominal pain during the early postpartum period. It mostly occurs in the right ovarian vein, and computed tomography (CT) is useful for diagnosis. We present a case of thrombophlebitis of the renal capsular vein. A 27-year-old postpartum woman presented with right lower abdominal pain and fever unresponsive to antibiotics. Contrast CT showed a ring-enhancing mass in the right retroperitoneum, which was distinct from the right ovarian vein. Exploratory laparoscopy revealed a retroperitoneal hematoma and normal appendix. Reconstruction of CT images revealed that the mass was connected to the right renal capsular vein. Anticoagulation therapy improved the patient’s symptoms. Postpartum thrombophlebitis can occur at locations other than the ovarian vein, such as the renal capsular vein. If a retroperitoneal mass is discovered during puerperium, a thorough investigation of the mass’s continuity with surrounding vessels is essential to avoid unnecessary surgery.

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Acute Testicular Torsion in Children: A Tertiary Hospital Experience in a Developing Country

Journal of Clinical Surgery and Research ◽

10.31579/2768-2757/024 ◽

2021 ◽

Vol 2 (4) ◽

pp. 01-03

Author(s):

Chukwubuike Kevin Emeka

Keyword(s):

Pediatric Surgery ◽

Testicular Torsion ◽

Undescended Testis ◽

Tertiary Hospital ◽

Prior History ◽

Testicular Pain ◽

History Of ◽

The Mean ◽

Urological Emergency ◽

The Right

Background: Testicular torsion is a urological emergency in which there is a race against time to salvage the testis. The aim of this study was to evaluate our experience in the management of children who presented with acute testicular torsion. Materials and Methods: This was a retrospective study of children aged 15 years and below who had surgery for acute testicular torsion between January 2013 and December 2017 at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. Results: Sixty-four children were managed during the study period. The ages of the patients ranged from 2 months to 14 years with a median of 6 years. The right testis was mostly affected and the mean duration from the onset of symptom to presentation was 4 hours. All the patients presented with testicular pain and half of the patients had a prior history of intermittent testicular pain. Four (6.3%) patients had a history of trauma precipitating the testicular torsion and 3 (4.7%) patients had undescended testis. Detorsion and Orchidopexy was the most performed surgical procedure and wound infection was the most common post-operative complication. There was no mortality. Conclusion: Testicular torsion is not uncommon in children and may be associated with testicular loss. The right testis is mostly involved in children. Prior history of intermittent testicular pain, trauma and undescended testis are important considerations. Prompt detorsion and orchidopexy remains the cornerstone of treatment.

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