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Magn Reson Imaging Clin N Am 2019 Feb 29;27(1):59-75. Epub 2018 Oct 29.

Department of Radiology, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267 Almada, Portugal; Department of Radiology, Hospital da Luz, Estrada Nacional 10, km 37, Setúbal 2900-722, Portugal. Electronic address:

Urinary tract infection (UTI) is among the most common of bacterial infections. Imaging studies are only required in cases of complicated UTIs. Ultrasound remains the first-line imaging method; however, CT is the gold standard for evaluation of UTIs. Read More

J Am Coll Radiol 2018 Nov;15(11S):S232-S239

Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama.

Pyelonephritis refers to infection involving the renal parenchyma and renal pelvis. In most patients, uncomplicated pyelonephritis is diagnosed clinically and responds quickly to appropriate antibiotic treatment. If treatment is delayed, the patient is immunocompromised, or for other reasons, microabscesses that form during the acute phase of pyelonephritis may coalesce, forming a renal abscess. Read More

Urologia 2018 Aug 26;85(3):123-126. Epub 2018 Mar 26.

Department of Urology, Grosshadern Clinics, University of Munich, Munich, Germany.

Introduction: Emphysematous pyelonephritis is a rare necrotizing infection of the kidney with a poor prognosis. If it occurs in patients with a reduced general condition, this infection is life threatening. Early diagnosis is made by computed tomography. Read More

J Clin Med 2018 Jul 14;7(7). Epub 2018 Jul 14.

Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan.

Emphysematous pyelonephritis is a rare but life-threatening infection characterized by an accumulation of gas in the renal parenchyma. A high mortality rate was reported, and timely administration of broad-spectrum antibiotics for enteric gram-negative bacilli, such as , , and , was recommended for improving the clinical outcome. Computed tomography is a useful tool for identifying gas accumulation within the perirenal space. Read More

Radiol Case Rep 2018 Aug 26;13(4):848-854. Epub 2018 Jun 26.

Atasemanso Hospital Limited, Kumasi, Ghana.

A 78-year-old black woman with a 10-year history of diabetes mellitus was admitted to the intensive care unit. Upon admission, she presented with chills, nausea, and left flank pain. The presence of hyperglycemia (fasting blood glucose, 19. Read More

Kidney Int Rep 2018 Jul 8;3(4):950-955. Epub 2017 Dec 8.

Nephrology, Ramaiah Medical College & Hospitals, Bangalore, India.

Introduction: Emphysematous pyelonephritis (EPN) is a rare, life-threatening necrotizing infection of the kidney. The mortality rate for EPN is as high as 25%. We conducted a retrospective study at MS Ramaiah Hospital between January 2011 and May 2016 to observe the clinical, biochemical, and microbiological patterns of EPN at our institute. Read More

J Int Med Res 2018 Jul 19;46(7):2954-2960. Epub 2018 Jun 19.

1 Department of Urology, First Hospital of Jilin University, Changchun, Jilin Province, China.

This present case report describes a 64-year-old female patient with type 2 diabetes mellitus who also had emphysematous pyelonephritis (EPN) and emphysematous cystitis (EC). Computed tomography revealed well defined emphysematous pyelonephritis and cystitis. Broad-spectrum antibiotic and percutaneous drainage of the right kidney were used as part of a conservative management regimen. Read More

J Emerg Med 2018 07 9;55(1):e1-e4. Epub 2018 May 9.

Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.

Background: Febrile urinary tract infections (UTIs) include a spectrum of pathologies from uncomplicated pyelonephritis to urosepsis, including xanthogranulomatous pyelonephritis (XGP). Most febrile UTIs are treated with antibiotics alone, but studies indicate nearly 12% of cases of presumed simple pyelonephritis require emergent urologic intervention. How to identify these individuals, while limiting unnecessary advanced imaging and delays in diagnosis, challenges all emergency providers. Read More

Acta Med Port 2018 Feb 28;31(2):129-132. Epub 2018 Feb 28.

Serviço de Medicina. Centro Hospitalar Cova da Beira. Covilhã. Portugal.

The emphysematous pyelonephritis is a uncommon and potentially fatal entity. The recognition of this condition enables the early correct management of patients. Diabetes and ureteral obstruction are the main risk factors identified. Read More

J Clin Imaging Sci 2018 21;8. Epub 2018 Feb 21.

Department of Radio-Diagnosis, Dr. D. Y. Patil Medical College and Research Center, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India.

Emphysematous pyelonephritis is a life-threatening severe form of pyelonephritis usually occurring in patients with diabetes mellitus with or without obstructive uropathies in whom there is necrotizing infection leading to the gas production of an unclear mechanism involving the renal parenchyma and the collecting system. Necrotizing fasciitis is characterized by progressive necrosis of fat and fascia due to deep-seated infection of subcutaneous tissue. It has a fulminant course with considerable mortality. Read More

JAMA Neurol 2017 11;74(11):1374-1375

Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania.

J Clin Diagn Res 2017 Jun 1;11(6):TC15-TC18. Epub 2017 Jun 1.

Associate Professor, Department of Radiology, Institute of Nephrourology, Bengaluru, Karnataka, India.

Introduction: Pyelonephritis (PN) is a suppurative infection of the kidney, most commonly due to bacterial infection and may be either acute or chronic. Acute PN (APN) subdivided into uncomplicated and complicated. Severity of PN cannot be assessed by clinical or laboratorial parameters alone, radiological imaging such as Ultrasound (USG) abdomen, Computed Tomography (CT) is required to know the nature, extent and severity of disease and for planning interventions. Read More

Am J Med Sci 2017 May 14;353(5):505. Epub 2016 Jul 14.

Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas.

Pan Afr Med J 2016 14;25:151. Epub 2016 Nov 14.

Service d'Urologie, Centre Hospitalier Universitaire Hassan II, Fès, Maroc.

Acute emphysematous pyelonephritis (EPN) is a severe kidney infection. Early and effective treatment is essential to reduce high mortality rates due to this disease. Our study aims to highlight the clinical and paraclinical features as well as the peculiarities of therapeutic management of this disease and focus on the possibility of conservative treatment in diabetic patients. Read More

Infect Chemother 2017 Mar 24;49(1):22-30. Epub 2017 Feb 24.

Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea.

Background: The objective of this study was to examine the usefulness of blood cultures and radiologic imaging studies for developing therapeutic strategies in community-acquired acute pyelonephritis (CA-APN) patients.

Materials And Methods: We prospectively collected the clinical data of CA-APN patients who visited 11 hospitals from March 2010 to February 2011.

Results: Positive urine and blood cultures were obtained in 69. Read More

Autops Case Rep 2016 Oct-Dec;6(4):41-47. Epub 2016 Dec 30.

Department of Pathology - Botucatu School of Medicine - Universidade Estadual Paulista "Júlio de Mesquita Filho" - Botucatu/SP, Brazil .

Emphysematous pyelonephritis is a rare infection characterized by necrosis and gas accumulation in the renal parenchyma, adjacent tissues, and/or urinary collecting system. This entity is rarely reported in transplanted kidneys. Computed tomography imaging is necessary for diagnosis and risk classification. Read More

Am J Med Sci 2017 Jan 15;353(1):93. Epub 2016 Mar 15.

Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.

Rev Med Interne 2018 Jul 9;39(7):600-601. Epub 2017 Jan 9.

Service de néphrologie et transplantation rénale, hôpital Foch, 40, rue Worth, 92151 Suresnes, France.

Transl Androl Urol 2016 Oct;5(5):774-779

Department of Urology, University of California San Francisco, San Francisco, California, USA.

Background: Emphysematous pyelonephritis is a severe infection of the kidney associated with formation of gas in the renal parenchyma and/or collecting system. The purpose of this study was to evaluate outcomes of patients with emphysematous pyelonephritis in a contemporary cohort and to evaluate the impact of urolithiasis on disease severity.

Methods: A search of all imaging reports at University of California San Francisco (UCSF) for the term "emphysematous pyelonephritis" was undertaken from 2003-2014. Read More

N Engl J Med 2016 Oct;375(17):1671

Kindai University, Osakasayama, Japan.

Am J Emerg Med 2017 03 22;35(3):520.e1-520.e2. Epub 2016 Sep 22.

Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD. Electronic address:

Hinyokika Kiyo 2016 Aug;62(8):415-9

The Department of Urology, Osaka General Medical Center.

A 40-year-old woman withuntreated type II diabetes mellitus was discovered withcardiopulmonary arrest in her room. On admission, she had ventricular fibrillation. After cardiopulmonary resuscitation, her own pulse restarted. Read More

Pediatr Infect Dis J 2016 10;35(10):1159-61

From the Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.

Emphysematous pyelonephritis is a severe necrotizing infection of the kidneys characterized by gas formation within the parenchyma, the collecting system or the perinephric tissue. To our knowledge, there have only been 4 cases of this condition reported in children. We report 2 additional cases in children managed at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. Read More

J Endourol Case Rep 2016 1;2(1):87-9. Epub 2016 Apr 1.

Department of Urology, Einstein Healthcare Network , Philadelphia, Pennsylvania.

Background: Staghorn calculi are well-established risk factors for recurrent urinary tract infections (UTIs) and subsequent renal deterioration. Less commonly, long-term urothelial irritation from a calculus may also pose a risk of malignant transformation.

Case Presentation: A 77-year-old male with multiple medical comorbidities presented with a chronic right renal pelvic staghorn calculus and findings concerning for emphysematous pyelonephritis. Read More

BJR Case Rep 2016 8;2(3):20150247. Epub 2016 May 8.

Department of Radiology, Government Kilpauk Medical College, Dr MGR Medical University, Chennai, India.

Fungal ball or fungal bezoar is the saprophytic colonization of a pre-formed cavity by a conglomerate of fungal mycelia without invasion of the adjacent tissue. Fungal bezoar is seen commonly in immunocompromised individuals. We describe the cross-sectional imaging characteristics of two cases of renal fungal ball, a rare clinical entity. Read More

Curr Probl Diagn Radiol 2017 Jan - Feb;46(1):74-83. Epub 2016 Feb 11.

Mallinckrodt Institute of Radiology, St. Louis, MO.

This article provides pictorial review of complicated upper and lower genitourinary infections and their mimics. Imaging features of upper urinary tract infections including uncomplicated acute pyelonephritis, xanthogranulomatous pyelonephritis (XGPN), emphysematous pyelonephritis, perirenal abscess, and pyonephrosis are first reviewed and then followed by pictorial review of their mimics including contrast-associated nephrotoxicity, renal infarcts, malakoplakia, renal cell cancer, leukemia or lymphoma and Castleman's disease. Next, imaging features of lower urinary tract infections including cystitis, emphysematous cystitis, enterovesical, colovesical and vesicovaginal fistulas, Fournier gangrene, prostatitis, epididymitis, and orchitis are reviewed and then followed by pictorial review of their mimics including gas in the bladder and perineum related to instrumentation, radiation cystitis, bladder cancer, testicular torsion, testicular trauma, and testicular cancer and lymphoma. Read More

CJEM 2017 01 18;19(1):63-64. Epub 2016 Mar 18.

Department of Emergency Medicine,E-Da Hospital,I-Shou University,Kaohsiung,Taiwan.

Pan Afr Med J 2015 23;22:186. Epub 2015 Oct 23.

Izmir Karsiyaka State Hospital, Emergency Department, Karsiyaka, Izmir, Turkey.

J Clin Diagn Res 2015 Nov 1;9(11):TD03-5. Epub 2015 Nov 1.

Senior Resident, Department of Radiodiagnosis, K V G Medical College & Hospital , Sullia, Dakshina Kannada, Karnataka, India .

Emphysematous pyelitis is a rare benign entity which is defined as isolated gas production in the pelvicalyceal system, ureters or in the urinary bladder as a consequence of acute bacterial renal infection. In this case report we present a case with no prior medical history of diabetes or urinary obstruction who presented with uncontrolled hyperglycaemia for the first time associated with emphysematous pyelonephritis. Further, the imaging differences between emphysematous pyelonephritis (EPN) and emphysematous pyelitis (EP) has been discussed along with the approach and their management. Read More

J Feline Med Surg 2016 Apr 24;18(4):357-63. Epub 2015 Aug 24.

Department of Small Animal Surgery, Animal Specialty and Emergency Center (ASEC), Los Angeles, CA, USA.

A 3-year-old male castrated domestic shorthair cat was presented with an acute history of lethargy and decreased appetite. Pertinent physical examination abnormalities included palpable irregularity of the right kidney and pain on palpation of the left kidney. Ultrasonographic imaging of the abdomen revealed gas present at the corticomedullary junction of the left kidney, consistent with emphysematous pyelonephritis, as well as emphysematous cystitis. Read More

Hong Kong Med J 2015 Aug;21(4):363-5

Department of Medicine, Dr RPGMC Kangra at Tanda, Kangra, 176001, Himachal Pradesh, India.

A 54-year-old male with long-standing diabetes presented with vague left flank pain for 5 days with uncontrolled blood glucose. The patient was commenced on insulin and injectable ceftriaxone empirically, for possibly acute pyelonephritis. Ultrasound examination revealed extensive emphysematous pyelonephritis of upper half of left kidney with involvement of perinephric space. Read More

Am J Emerg Med 2015 Dec 24;33(12):1846.e3-6. Epub 2015 Apr 24.

Binzhou Medical University, No. 346, Guanhai Road, Laishan District, Yantai 264003, Shandong, China. Electronic address:

Emphysematous pyelonephritis is a severe necrotizing infection characterized by the presence of gas and/or fluid in the renal parenchyma, collecting system, or perirenal tissues. Emphysematous pyelonephritis with approximately 15 cm air-fluid level, diffused ureteral involvement, and the accumulation of gas in liver and peritoneal cavity is very rare. Here, we reported a severe emphysematous pyelonephritis with multiple huge air-fluid level mimicking intestinal obstruction and with the accumulation of gas in liver and ureter in computed tomography imaging. Read More

Ugeskr Laeger 2015 Mar;177(14):V10140576

Urologisk Afdeling, Roskilde Sygehus, Køgevej 7-13, 4000 Roskilde.

Emphysematous pyelonephritis (EPN) is a potentially life-threatening infection, where gas produced by bacteria accumulates in the kidney and the surrounding tissue. Although EPN usually presents in diabetic women, it is also associated with urinary tract obstruction and kidney tumours in non-diabetic patients. We present a case of EPN in a non-diabetic patient with a known kidney tumour, successfully treated with double-J catheter, antibiotics and delayed nephrectomy. Read More

Hemodial Int 2015 Oct 3;19(4):E54-8. Epub 2015 Feb 3.

Department of Nephrology, "Asklepieion" General Hospital, Athens, Greece.

Emphysematous pyelonephritis (EPN) is a life-threatening renal infection caused by gas-producing bacteria and fungi. It usually occurs in patients with diabetes and patients with urinary tract obstruction. A combination of systemic antibiotics, percutaneous catheter drainage, or open nephrectomy is typically required to achieve cure. Read More

Ugeskr Laeger 2015 Jan;177(2A):110-1

Vandtårnsvænget 15, 6400 Sønderborg.

Emphysematous pyelonephritis is an acute severe necrotizing infection of the renal parenchyma and its surrounding tissues and up to 95% of the patients have diabetes. We describe a concurrent manifestation of emphysematous pyelonephritis and ischaemic colitis in a 51-year-old diabetic woman and conclude that the colitis was due to pressure from a large retroperitoneal mass and sepsis complications combined with underlying peripheral vascular disease because of diabetes mellitus and hypertension. Read More

World J Radiol 2014 Nov;6(11):865-73

Chandan J Das, Zohra Ahmad, Sanjay Sharma, Arun K Gupta, Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Delhi 110029, India.

Spectrum of acute renal infections includes acute pyelonephritis, renal and perirenal abscesses, pyonephrosis, emphysematous pyelonephritis and emphysematous cystitis. The chronic renal infections that we routinely encounter encompass chronic pyelonephritis, xanthogranulomatous pyelonephritis, and eosinophilic cystitis. Patients with diabetes, malignancy and leukaemia are frequently immunocompromised and more prone to fungal infections viz. Read More

N Engl J Med 2014 Nov;371(22):e34

Taipei Medical University, New Taipei City, Taiwan.

Intern Med 2014 1;53(21):2557. Epub 2014 Nov 1.

Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Japan.

Malays J Med Sci 2014 May;21(3):85-8

Department of Medicine, Dr. D. Y. Patil Medical College and Hospital, Pimpri, Pune 411018, India.

Emphysematous pyelonephritis (EPN) is a rare, severe infection of renal parenchyma presenting commonly with fever and flank pain and presence of gas in the renal and/or peri-renal space. EPN can be life threatening if not diagnosed and treated promptly. Air shadows in the renal or peri-renal region on imaging studies of the abdomen are diagnostic features of EPN. Read More

Saudi J Kidney Dis Transpl 2014 Sep;25(5):1086-7

Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Hippokratia 2013 Oct;17(4):373-5

Internal Medicine Departmen, General Hospital of Katerini, Katerini, Greece.

Background/aim: Emphysematous pyelonephritis (EP) is an acute necrotic infection of the kidney which is characterized by the presence of gas. Uncontrolled diabetes mellitus and obstruction of the urinary tract are the main predisposing factors and Escherichia Coli is the most frequent causative pathogen.

Case Report: We herein report a case of a patient with undiagnosed diabetes mellitus who was admitted to the emergency department with symptoms of pyelonephritis. Read More

Saudi J Kidney Dis Transpl 2014 Jul;25(4):823-9

Department of Internal Medicine, Armed Forces Medical College, Pune, India.

Emphysematous pyelonephritis (EPN) is a group of potentially life-threatening conditions seen particularly in diabetics, leading to high morbidity and mortality. Our aim was to study the profile of emphysematous infections of the kidney and urinary tract and evaluate the effect of early surgical intervention on mortality. This is an observational study conducted in a tertiary care hospital between January 2009 and January 2013, in which the clinical, laboratory, microbiological and radiological profiles of patients with EPN (diagnosed based on clinical, laboratory and imaging findings) was studied. Read More

QJM 2015 Jan 13;108(1):73. Epub 2014 Jun 13.

Department of Internal Medicine, Madurai Medical College, Madurai, India.

Br J Hosp Med (Lond) 2014 Apr;75(4):235

Professor of Nephrology in the Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

BMJ Case Rep 2014 Apr 4;2014. Epub 2014 Apr 4.

Department of Urology, Darent Valley Hospital, Kent, UK.

Intern Emerg Med 2014 Dec 11;9(8):893-4. Epub 2014 Mar 11.

Clinical Department Organization, Vigor Medical Institute, 131, Daxing W Rd Sec 2, Taoyuan, 330, Taiwan, ROC.

Nihon Hinyokika Gakkai Zasshi 2014 Jan;105(1):22-5

Department of Urology, Nagahama City Hospital.

A 76-year-old diabetic woman was referred to our hospital with an episode of high fever and sub-abdominal pain. Computed tomography (CT) of the pelvis revealed gas accumulation within the lumen and wall of the bladder and CT of the abdomen demonstrated bubbles in the inferior vena cava. She recovered by urinary drainage and antibiotic therapy. Read More

Indian J Urol 2014 Jan;30(1):108-9

Department of Urology, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India.

Hepatic portal venous gas (HPVG) is an uncommon radiological sign and often portends significant underlying abdominal disease. A number of conditions may produce this sign and identifying the underlying etiology is essential for management. The advent of ultrasonography-color Doppler imaging and computerized tomography has led to more frequent recognition of this condition. Read More

J Am Anim Hosp Assoc 2014 Mar-Apr;50(2):124-9. Epub 2014 Jan 20.

Veterinary Medical Teaching Hospital, College of Veterinary Medicine, Kansas State University, Manhattan, KS.

Emphysematous cystitis (EC) and emphysematous pyelonephritis (EPN) are the result of infection of the urinary bladder and kidneys by gas-producing microorganisms. Those infections are most often reported in diabetic patients and rarely occur concurrently. This article describes two cases of concurrent EC and EPN, one in a nondiabetic dog and the other in a diabetic cat. Read More

Acta Radiol 2015 Feb 17;56(2):244-9. Epub 2014 Jan 17.

Department of Radiology, TN Medical College, Mumbai, India.

Background: Imaging is vital in diagnosis of complicated pyelonephritis and has been traditionally performed by computed tomography (CT). However, CT with contrast agents cannot be performed in patients with renal failure. Diffusion-weighted (DW) magnetic resonance imaging (MRI) has the potential to overcome this disadvantage. Read More