PMC4397714_01
Emphysematous pyelonephritis (EPN) of the right kidney. Computed tomography scan demonstrates right-sided EPN with enlarged right kidney and normal left kidney. Gas is present in the renal pelvis, in the proximal ureter (red arrows), and in a posterior cyst of the right kidney (white arrows). There is also significant perirenal infiltration (blue arrows).
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Fig1
Few minutes after her admission, the patient's blood pressure dropped dramatically with anuria and hypoxemia, so she received oxygen therapy (10 L/min with a reservoir mask) and intravenous fluid therapy with 1,500 mL of crystalloid (Ringer lactate) and 500 mL of colloid (6% hydroxyethyl starch 130/0.4).Urgent abdominal computed tomography (CT) scan permitted the diagnosis of EPN showing a pyonephrosis of the right kidney and presence of pneumaturia in the collecting system and in a cyst located in the lower pole of the right kidney (Figure 1).
The 2-month follow-up computed tomography scan. The follow-up computed tomography scan shows the normalizing size and complete absence of gas in the right kidney. A small posterior cyst of the right kidney is still present (red arrow). Perirenal infiltration has almost disappeared (blue arrows).
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Fig2
She underwent an abdominal CT scan 2 months later (Figure 2) showing regression of the right pyonephrosis with normal parenchyma, no dilatation, and persistence of a right renal cyst of reduced diameter.