氣腫性腎盂腎臟炎

Radiological Diagnosis of Emphysematous Pyelonephritis

周以和(Yii-Her Chou) ； 江金培(Chin-Pei Chiang) ； 黃俊雄(Chun-Hsiung Huang) ； 陳明潭(Min-Tan Chen) ； 何耀輝(Yau-Hui Ho)

《中華放射線醫學雜誌》 10卷2期 (1985/06) Pp. 166-170

摘要

正常情形下，腎臟不應有氣體存在。氣腫性腎盂腎臟炎是一稀少而嚴重的尿路感染症，它的特徵為腎臟發生化膿性感染合併氣體產生。此症世界文獻只有70例被報告過。氣腫性腎盂腎臟炎主靠放射線診斷，X光可見氣體散佈於腎實質或腎周圍。此氣體易與後腹膜腔發炎引起的腸積氣混淆而錯過診斷，此症也常被當做阻塞性腸積氣來治療。本文報告三個病例，第二例與第三例就曾被當做腸阻塞治療過。此病的臨床表徵、病理機轉及放射線診斷所見亦一併提出討論。

並列摘要

Emphysematous pyelonephritis is an unusual condition in which there is gas within the kidney. It is a rare but frequently fatal renal infection. It is characterized by suppurative infection in the renal parenchyma with spontaneous gas production within or around the kidney. This disease is encountered mainly in middle-aged and uncontrolled diabetics. Urinary tract obstruction was present in one-third to one-half of the cases. Aproximately 70 cases of emphysematous pyelonephritis have been reported in the literature.
The clinical manifestations of patients with emphysematous pyelonephritis usually resemble severe acute pyelonephritis. The diagnosis of this disease is confirmed by the roentgenological examination. The radiological signs include diffuse mottling of the renal parenchyma, radial distribution of gas bubbles along the pyramids or within the tubules, bubbly renal parenchyma surrounded by a crescent of gas, sometimes, gas could extend byond renal capsule and be seen in the retroperitoneal space and even crepitus in the overlying tissue might exist. An excretory urogram demonstrated non-visualization of the involved kidney in 45% of the cases. CT scan could demonstrate clearly the renal excretion of contrast media and define the extent of gas distribution.
Here we are reporting 3 cases of emphysematous pyelonephritis confirmed by radiological and bacterial examinations. Case 2 and 3 have been treated as mechanical ileus prior to reach the correct diagnosis. CT scan has been performed on case 2. The pathological, radiological and clinical features of this entity were discussed as well.