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Am J Case Rep 2019 Dec 2;20:1793-1796. Epub 2019 Dec 2.

Department of Internal Medicine, KAT General Hospital of Attica, Kifissia, Greece.

BACKGROUND Emphysematous osteomyelitis of the spine is characterized by intravertebral or intraosseous air. Emphysematous pyelonephritis (EP) is the infection of the renal parenchyma and perirenal tissues caused by gas forming microorganisms and thus is characterized by gas formation. Prompt diagnosis and initiation of necessary treatment is crucial, as both entities are associated with high mortality rates. Read More

Can Assoc Radiol J 2019 Nov 17;70(4):424-433. Epub 2019 Sep 17.

Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada. Electronic address:

Purpose: To review the computed tomography and magnetic resonance imaging manifestations of acute and chronic renal infections that may mimic malignancy and to provide useful tips to establish an imaging diagnosis.

Conclusion: Acute and chronic bacterial pyelonephritis are usually readily diagnosed clinically and on imaging when the diagnosis is suspected based upon clinical presentation. When unsuspected, focal, extensive or mass-like, acute and chronic bacterial pyelonephritis may mimic infiltrative tumours such as urothelial cell carcinoma (UCC), lymphoma, and metastatic disease. Read More

BMJ Case Rep 2019 Sep 12;12(9). Epub 2019 Sep 12.

Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Pondicherry, India.

Emphysematous pyelonephritis (EPN) can present with symptoms due to infection or sepsis. EPN presenting with renal vein and inferior vena cava (IVC) thrombus is very rare. We report a case of EPN with renal vein and IVC thrombus and its management. Read More

Int Urol Nephrol 2019 Oct 15;51(10):1709-1713. Epub 2019 Jul 15.

Mefrek Hospital, Abu Dhabi, United Arab Emirates.

Purpose: In view of the differences in early and late management experiences based on Huang and Tseng CT classification of emphysematous pyelonephritis (EP), our study included 34 patients aimed to re-correlate the current management plans with CT classification.

Methods: A retrospective review from January 2009 to December 2018, in patients with primary or final diagnosis of EP. Data included; patients' demographics, routine laboratory and imaging work-up. Read More

Clin Exp Nephrol 2019 Oct 3;23(10):1257-1258. Epub 2019 Jul 3.

Division of Nephrology, University of Texas At San Antonio, 7703 Floyd Curl Dr, MC 7882, San Antonio, TX, 78229, USA.

Saudi J Kidney Dis Transpl 2019 May-Jun;30(3):706-709

Saudi Center for Organ Transplantation, Riyadh, Saudi Arabia.

Diabetes mellitus (DM) is a common disease in Oman as in rest of Gulf Cooperation Council where metabolic syndrome is of high prevalence. DM is a foremost risk factor for urinary tract infections (UTIs). It is also linked to more complicated infections such as emphysematous pyelonephritis (EPN), emphysematous pyelitis (EP), renal/perirenal abscess, emphysematous cystitis, xanthogranulomatous pyelonephritis, and renal papillary necrosis. Read More

Indian J Med Res 2019 03;149(3):428-429

Department of Urology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry 605 006, India.

BMJ Case Rep 2019 Jun 5;12(6). Epub 2019 Jun 5.

Internal Medicine, Saint Joseph Hospital, Chicago, Illinois, USA.

Indian J Med Res 2018 Dec;148(6):759-760

Department of Radiodiagnosis & Interventional Radiology, Amrita Institute of Medical Sciences & Research Centre, Kochi 682 041, Kerala, India.

BMJ Case Rep 2019 Feb 13;12(2). Epub 2019 Feb 13.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Postgrad Med J 2018 12 20;94(1118):714-715. Epub 2018 Dec 20.

Department of Diabetes, Metabolic Diseases and Endocrinology, Fortis CDOC Hospital, New Delhi, India.

Intensive Care Med 2019 04 6;45(4):525. Epub 2018 Dec 6.

AIIMS, Rishikesh, Rishikesh, India.

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 Infect Chemother 2019 Apr 15;25(4):302-306. Epub 2018 Nov 15.

Second Department of Internal Medicine, Nagasaki University, Nagasaki, Japan; Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

Emphysematous pyelonephritis (EPN) is a life-threatening renal infection characterized by the formation of gas within the renal parenchyma and collecting duct system, as well as perinephric tissues. We herein report a case of bilateral EPN accompanied by the urinary tract infection caused by spherical growth of Candida albicans in a patient with underlying diabetes mellitus and prostate cancer. The diagnosis was assisted by computed tomography, urography, and gram staining. Read More

Transpl Infect Dis 2019 Feb 4;21(1):e13026. Epub 2018 Dec 4.

Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan.

Emphysematous pyelonephritis (EPN) is a rare condition which can rapidly progress to sepsis and multiple organ failure with high mortality. We experienced a rare case of EPN in a renal allograft related to antibody-mediated rejection (AMR). The patient received a deceased donor kidney transplant due to end-stage renal disease secondary to diabetes mellitus. 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

S D Med 2017 Nov;70(11):511-513

Sanford Pathology, Sioux Falls, South Dakota.

We present a 37-year-old female with a history of tuberous sclerosis. She developed flank pain, hypotension, and a sudden drop in hemoglobin levels which prompted a work-up. A computed tomography scan demonstrated enlarged heterogeneous kidneys and a large complex collection in the right kidney, likely hemorrhagic in nature. 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