Diagnostic Ultrasound - Abdomen and Pelvis

Emphysematous Pyelonephritis
(Left) On noncontrast CT,
chronic obstruction and
infection in this patient's left
kidney have caused marked
cortical thinning , with
replacement of pelvis and
parenchyma by a contained
gas and fluid collection .
(Right) Axial CT in another
patient with emphysematous
pyelonephritis shows focal
intraparenchymal gas in
the upper pole of the left
kidney. Note surrounding
inflammatory changes ,
which suggests this infection is
chronic.
Diagnoses: Urinary Tract
(Left) Coronal CT from the
same patient again illustrates
minimal intraparenchymal gas
. Also note other signs of
infection including marked
enlargement of the left
kidney, delayed nephrogram,
cortical abscess , and
urothelial thickening of the
renal pelvis . (Right) Axial
CT more inferiorly in the same
patient shows foci of gas
within thick-walled collections
in both psoas muscles
associated with the patient's
emphysematous
pyelonephritis.
(Left) Axial post-contrast T1
weighted MR in the same
patient at a similar level
confirms bilateral psoas
abscesses . (Right) Sagittal
T2-weighted MR in the same
patient reveals abnormal
hyperintense signal in the
adjacent L4 vertebral body ,
indicating developing
osteomyelitis. This diabetic
patient with emphysematous
pyelonephritis, psoas
abscesses, and vertebral body
osteomyelitis presented with
sepsis and severe back pain.
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