Air in the urinary system.

摘要

A 76-year-old man presented with a 2-day history of progressive and sharp lower abdominal pain of moderate severity, associated with urinary frequency and hematuria. Medical history included uncontrolled type 2-diabetes mellitus, stage 3 chronic kidney disease and neurogenic bladder. He had self-catheterized himself for 1 year. Physical findings were tenderness in the left lower quadrant and suprapubic area. Computed tomography scan of the abdomen showed bilateral small kidneys with hydronephro-sis. The bilateral haziness and strands in the perinephric fat and thickening of Gerota's fascia (Figure 1, vertical arrow in panel B) are suggestive of pyelonephritis. Air seen in the dilated left kidney pelvis (Figure 1, horizontal arrow in panels A and B) and in the wall of the urinary bladder (Figure 1, oblique arrow in panels A and C) is characteristic of emphysematous pyelonephritis and emphysematous cystitis, respectively. Urine culture was positive for Klebsiella oxytoca and Escherichia coli. The infection resolved with antibiotic therapy.