Case 1-1-2
A 75-year-old diabetic woman presented with fever and fl ank pain.
1. Describe the images and the most likely diagnosis?
2. What is the aetiology?
3. What is the radiographic differential diagnosis?
Answers to Case 1-1-2
1. Plain film of the abdomen (Fig. 1-1-2 a ) with a magnifi ed image of the left upper
quadrant (Fig. 1-1-2 b ). There is an abnormal gas shadow outlining the left pelvicalyceal
system and a further gas shadow centrally in the pelvis which outlines the
bladder. Appearances are highly suggestive of emphysematous pyelonephritis.
2. This is an acute, life-threatening infection of the kidney with gas formation. It
is associated with diabetes most commonly, but also immunocompromise or
ureteric obstruction. The usual organisms are E. coli, Klebsiella or Proteus .
3. Similar radiographic appearances may be seen with enterovesical fi stula (iatrogenic,
tumour, Crohn’s disease), a psoas abscess fi stulating into the renal collecting
system or after recent endourological intervention.
Craig WD, Wagner BJ, Travis MD. Pyelonephritis: radiologic-pathologic review.
Radiographics . 2008;28(1):255–277.