Emphysematous pyelonephritis j yao1, om gutierrez2 and j reiser2 1renal division, department of medicine, brigham and womens hospital and harvard medical school, boston, massachusetts, usa. Imaging is essential to managing emphysematous pyelonephritis a lifethreatening, fulminant, necrotizing upper urinary tract infection associated with gas within the kidneyif an early diagnosis is to be made and a potentially devastating outcome is to be avoided. Perirenal, anterior pararenal and posterior pararenal spaces on the right showed air tracking. Traditional therapy for epn is nephrectomy or open surgical drainage and appropriate. Imaging is essential to managing emphysematous pyelonephritis a lifethreatening, fulminant, necrotizing upper urinary tract infection. Ct is the best diagnostic modality for emphysematous pyelonephritis, and it may show the following diagnostic features. In different series, diabetes was present in more than 80 percent of patients with. The imaging findings of emphysematous pyelonephritis and the clinical setting in which the diagnosis should be considered. Joint urology emphysematous pyelonephritis slideshare. Emphysematous pyelonephritis epn is a severe, necrotizing renal parenchymal infection. The ct classification system to direct management of patients with.
Left kidney is enlarged with poor corticomedullary differentiation. Emphysematous pyelonephritis epn is a group of potentially. Linear air shadow is noted in left renal lower parenchymal and in the perinephric region. Emphysematous pyelonephritis, a rare cause of pneumoperitoneum. Suspect emphysematous pyelonephritis epn in unwell elderly patients with diabetes with a fever of unknown origin, or whose clinical presentation is suggestive of a urinary tract infection.
Imaging studies used for diagnosis of emphysematous pyelonephritis include the following. Emphysematous cystitis is a rare type of infection of the bladder wall by gasforming bacteria or fungi. A 58yearold woman with a past medical history of hypertension and arthritis presented to the emergency department of the massachusetts general hospital complaining of 1 week of progressive. Risk factors for emphysematous pyelonephritis are diabetes. Prompt ct imaging is vital in establishing a diagnosis of epn and ruling out other causes for intraabdominal sepsis. A total of 11 nephrectomy specimens of epn received in the surgical. Emphysematous pyelonephritis complicated by hemorrhage. Option d emphysematous pyelonephritis caused by klebsiella species is correct. Emphysematous pyelonephritis epn is a rare, lifethreatening, necrotizing complication of pyelonephritis, which is usually associated with uncontrolled diabetes. Usually occurs in diabetics with uncontrolled sugar, usually in age group of 1985 mean age 55. Case series, report by canadian urological association journal cuaj. An xray not shown and computed tomogram of the abdomen suggested a diagnosis of emphysematous pyelonephritis. Emphysematous pyelonephritis epn is a severe, necrotizing infection of the renal parenchyma. They state, given the high risk of death associated with conservative.
Indium111 labelled leucocyte scanning and computed tomography confirmed the presence of infection preoperatively in a diabetic patient with emphysematous pyelonephritis. Emphysematous pyelonephritis the medical journal of. Emphysematous pyelonephritis is a rare, lifethreatening disease characterized by gas in the renal or perirenal tissues. Ultrasound is insensitive to the changes of acute pyelonephritis, with most patients having normal scans. Imaging of acute pyelonephritis in the adult springerlink. Emphysematous pyelonephritis a case series from a single. Emphysematous pyelonephritis epn is a rare, severe gasforming infection of renal parenchyma and its surrounding areas. Hospital medicine 2008, april 35, san diego, calif.
Current management of emphysematous pyelonephritis pubmed. It is rapidly progressive, requiring appropriate therapy. Emphysematous pyelonephritis should be suspected in every diabetic patient, presenting with features. Ct is the best imaging modality for depicting this disease process, as it is sensitive in localizing precisely air within the pelvicalyceal system rather than in the renal parenchyma andor perinephric space. Emphysematous pyelonephritis epn is a urologic emergency. Abnormalities are identified in only 25% of cases 1. Emphysematous pyelonephritis epn or cystitis ec, usually occurred in diabetes, is a severe infection of the urinary tract with mortality of 8. Emphysematous pyelonephritis epn is an acute severe necrotizing infection of the renal parenchyma and its surrounding tissues that results in the presence of gas in the renal parenchyma, collecting. The objective was to study the pathological features of emphysematous pyelonephritis epn. Dr e dhandapanis unit slideshare uses cookies to improve functionality and performance, and to provide you with. Gas in the found in the kidney, which must be reported.
Emphysematous pyelonephritis epn is a rare but potentially lifethreatening necrotizing renal parenchymal infection characterized by the production of intraparenchymal gas. Emphysematous pyelonephritis and cystitis in a patient. Imaging features and guided drainage in emphysematous. Imaging is essential to managing emphysematous pyelonephritis a life threatening, fulminant, necrotizing upper urinary tract infection. Emphysematous pyelonephritis risks, symptoms and leading. Normally, the clinical management of emphysematous pyelitis and emphysematous pyelonephritis are different. Emphysematous pyelonephritis refers to a morbid infection with particular gas formation within or around the kidneys. Kidney, ureter, bladder kub radiographs renal ultrasonography. Emphysematous pyelonephritis in a diabetic leading to. Objectives emphysematous pyelonephritis is a severe necrotizing infection of the. Emphysematous pyelonephritis epn is a severe necrotizing. Emphysematous pyelonephritis epn is an acute severe necrotizing infection of the renal parenchyma and its surrounding tissue and leads to gas production in the renal parenchyma, collecting system, or. The educational component consists of three required articles that the participant should read.
However, with increasing availability and decrease in the threshold for using imaging modalities like ultrasonography and ct. Features suggestive of grade 3b huangtseng ct classification right emphysematous pyelonephritis were also noted. We retrospectively analyzed the clinical and laboratory data, imaging. Emphysematous pyelonephritis in renal allograft recipients is a rare but. Emphysematous pyelonephritis is a gasproducing necrotizing bacterial infection that involves the renal parenchyma and perirenal tissue. Emphysematous pyelonephritis epn is a necrotizing renal infection characterized by perirenal gas production. The educational objectives for this selfassessment module are for the participant to exercise, selfassess, and improve his or her understanding of the role of imaging in the diagnosis of. The treatment of choice is medical stabilization, followed by judicious surgical. Our experience with conservative management in 14 cases pramod kumar sharma 1, ritu sharma 2, mukesh k vijay 1, punit tiwari 1, amit goel 1, anup k kundu 1 1. Current management of emphysematous pyelonephritis. She subsequently underwent open drainage with doublej stenting. The widespread availability of imaging techniques leads to early diagnosis and a reduction of mortality of renal and periphrenic abscesses and even of emphysematous pyelonephritis. Emphysematous pyelonephritis epn is a rare and severe form of acute pyelonephritis.
Emphysematous pyelonephritis radiology reference article. Over the next few hours, the patient developed septic shock. The radiological classification and adequate therapeutic regimen are. Introduction this selfassessment module on the imaging evaluation of emphysematous pyelonephritis has an educational component and a selfassessment component. We present the imaging we present the imaging features of nine patients with proven. Clinical characteristics of emphysematous pyelonephritis. The diagnosis of acute pyelonephritis in adults is predominantly made by a combination of typical clinical features of flank pain, high temperature and dysuria combined with urinalysis.
In such patients, imaging may not only aid in making the diagnosis of acute pyelonephritis, but more importantly, it may help identify complications such as. Ct imaging is invaluable in diagnosing emphysematous. Emphysematous pyelonephritis epn has been defined as a necrotizing infection of the renal parenchyma and its surrounding areas that results in the presence of gas in the renal. Emphysematous pyelonephritis is a severe, necrotizing, renal parenchymal infection that is characterized by the production of intraparenchymal gas. Emphysematous pyelonephritis is a serious complication of acute pyelonephritis with high mortality 43%. Imaging of acute pyelonephritis in the adult request pdf. The diagnosis of acute pyelonephritis apn requires. Urine culture and sensitivity showed escherichia coli. Emphysematous cholecystitis is a severe form of acute cholecystitis and can be rapidly fatal. Sonographic signs of pyelonephritis are nonspecific and only useful in comparison with previous imaging. This selfassessment module on the imaging evaluation of emphysematous pyelonephritis has an educational component and a selfassessment component. The selfassessment component consists of 10 multiplechoice questions with solutions. Emphysematous pyelonephritis epn is an uncommon infection characterized by gas in the renal parenchyma and surrounding tissues. Epn is a rare and severe infection of the renal parenchyma.
Diabetes mellitus and urinary tract obstruction are the major risk factors for emphysematous urinary tract infections utis. A 67yearold woman with diabetes and poor glycemic control who had recently been treated for pyelonephritis presented to. If not treated early, it may lead to fulminant sepsis and, therefore, carries a high mortality. Chronic pyelonephritis is a somewhat controversial disease from a pathogenetic standpoint. Imaging in emphysematous pyelonephritis the use of. Despite the ongoing debate on whether the condition is an active chronic infection, arises from multiple recurrent infections, or represents stable changes from a remote single infection, its radiologic appearance is the same. Emphysematous pyelonephritis international surgery journal. Imaging is essential to managing emphysematous pyelonephritis a lifethreatening, fulminant, necrotizing upper urinary tract infection associated with gas within the kidneyif an early diagnosis is.
560 186 1155 620 743 401 686 165 1368 1431 391 91 922 971 1047 1282 413 1066 865 780 40 626 10 239 1018 743 477 569 936 1329 1117 906 225 946