CT as a Diagnostic Tool for Emphysematous Pyelitis: A Case Report

Gas forming infections of the renal collecting system occurs because of organisms like Escherichia coli, Klebsiella, and Proteus. If the gas is restricted to the collecting system, without causing involvement of the cortex, it is called emphysematous pyelitis; whereas, invasion and penetration of the cortex imply a more gruesome diagnosis of emphysematous pyelonephritis. A 59-year-old male patient, previously diagnosed with a large right renal calculus and having multiple co-morbidities presented to the surgery department with right flank pain; Double J (DJ) stenting was done to relieve the pain from colic due to obstructive renal calculi; the patient subsequently discharged without any post-procedural complications. The patient came back a month later with similar complaints and multiple spikes of fever. Blood and urine culture revealed growth of Escherichia coli. The first line radiological investigations, like X-ray and ultrasonography, were suggestive of the presence of air in the pelvis, ureter, bladder; confirmation by CT revealed the presence of air in the collecting system, including the calyx. This air was seen invading focally into the anterior renal cortex. Also, the DJ stent had migrated into the proximal ureter.  The patient had developed emphysematous pyelitis predominantly, which had developed an overlapping component of pyelonephritis. The aetiology for air in the renal system was infection by Escherichia coli. CT proved to be diagnostic in differentiating both of them, as the presence of air entering the renal cortex was detected only on CT. Subsequently, prominent initiation of antibiotic therapy and replacement of DJ stent was carried out, following which the patient recovered fully within two weeks.

An Unexpected Complication After Extracorporeal Shock Wave Lithotripsy: Emphysematous Pyelitis

Emphysematous urinary tract infections (UTI) are life-threatening conditions caused by gas-forming organisms. Emphysematous pyelitis (EP) is a rare, acute bacterial UTI characterized by gas formation only in the renal collecting system. Extracorporeal shock wave lithotripsy (ESWL) treatment was performed for 10-mm sized stone in the left renal pelvis in an 81-year-old female patient with no known comorbidities other than hypertension. In the 10th hour following ESWL treatment, the patient referred to the emergency department with fever and left flank pain. Gas was noticed in the left renal collecting system in non-contrast computed tomography (NCCT). A wide spectrum antibiotic was given to the patient due to EP diagnosis and a nephrostomy catheter was placed in the left renal pelvis. EP should be considered in the patient with fever and flank pain after ESWL and NCCT should be performed for further examination. Quick diagnosis, examination and treatment of these patients in the emergency department are important.

Perinephric Abscess Causing Mycotic Celiac and Splenic Artery Aneurysm: A Case Report

Perinephric abscess is a known complication of urologic infection, sometimes requiring surgical debridement. Extension into adjacent structures is rarely reported. We present a case of a woman with xanthogranulomatous emphysematous pyelonephritis accompanied by massive perinephric abscess, resulting in celiac and splenic artery mycotic aneurysms via direct invasion.

Complicated urinary tract infections associated with diabetes mellitus: Pathogenesis, diagnosis and management

Diabetes mellitus has a number of long-term effects on the genitourinary system. These effects predispose to bacterial urinary tract infections (UTIs) in the patient with diabetes mellitus. Complicated UTIs are also common and potentially life-threatening conditions. They include emphysematous pyelonephritis, emphysematous pyelitis/cystitis, xanthogranulomatous pyelonephritis, renal/perirenal abscess, and renal papillary necrosis. Improved outcomes of these entities may be achieved by early diagnosis, knowledge of common predisposing factors, appropriate clinical and radiological assessment, and prompt management. Herein we review complicated UTIs associated with diabetes mellitus in terms of pathogenesis, clinical manifestations, radiological features, and current management options.