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)
|Volume or Term/Year and Month of Publication||
10卷2期（1985 / 06 / 01）
166 - 170
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.