CT as a Diagnostic Tool for Emphysematous Pyelitis: A Case Report

Abstract

Gas forming infections of the renal collecting system occurs because of organisms like Escherichia coli, Klebsiella, and Proteus. If the gas is restricted to the collecting system, without causing involvement of the cortex, it is called emphysematous pyelitis; whereas, invasion and penetration of the cortex imply a more gruesome diagnosis of emphysematous pyelonephritis. A 59-year-old male patient, previously diagnosed with a large right renal calculus and having multiple co-morbidities presented to the surgery department with right flank pain; Double J (DJ) stenting was done to relieve the pain from colic due to obstructive renal calculi; the patient subsequently discharged without any post-procedural complications. The patient came back a month later with similar complaints and multiple spikes of fever. Blood and urine culture revealed growth of Escherichia coli. The first line radiological investigations, like X-ray and ultrasonography, were suggestive of the presence of air in the pelvis, ureter, bladder; confirmation by CT revealed the presence of air in the collecting system, including the calyx. This air was seen invading focally into the anterior renal cortex. Also, the DJ stent had migrated into the proximal ureter. The patient had developed emphysematous pyelitis predominantly, which had developed an overlapping component of pyelonephritis. The aetiology for air in the renal system was infection by Escherichia coli. CT proved to be diagnostic in differentiating both of them, as the presence of air entering the renal cortex was detected only on CT. Subsequently, prominent initiation of antibiotic therapy and replacement of DJ stent was carried out, following which the patient recovered fully within two weeks.

Case Report of an Atypical Abdominal Pain Found to be a Rare Corynebacterium Emphysematous Pyelitis

“…Diagnosis is made via CT, which is the imaging of choice and is considered the most sensitive and specific modality for the evaluation of emphysematous pyelonephritis [ 10 ]. Classification and staging of emphysematous pyelonephritis are based on radiological findings of the extension/presence of air in the collecting system and calyx [ 11 ]. CT allows for the evaluation of the renal parenchyma as well as to differentiate between gas, fluids, and stones.…”

Development of a loop-mediated isothermal amplification method for the rapid detection of Clostridium botulinum serotypes E and F

“…In parallel, we conducted LAMP and PCR experiments to test the speci city of the primers. The speci city of the LAMP reaction to detect C. botulinum serotypes E and F were veri ed by using six other different Clostridium species, and eight food poisoning-isolated bacterial species [22,23,24] (Table 3) did not show ampli cation signals with target DNA when tested by the LAMP method (Fig. 6C, 6D).…”