Venous gas caused by emphysematous pyelonephritis: a case report and review of literature

Abstract

Background: Emphysematous pyelonephritis (EPN) is a potentially life-threatening disease caused by a gas-producing necrotizing bacterial infection that involves the renal parenchyma, collecting system, and/or perinephric tissue. EPN is often complicated by a previous diagnosis of diabetes mellitus, and venous air bubbles are an uncommon complication of it. We describe a 52-year-old woman who was admitted in coma, with a history of vomiting, and was found to have EPN with air bubbles in the uterine veins. We discuss the presentation, diagnosis, and pathogenesis of this uncommon but clinically significant event, and briefly review other case reports of venous gas or thrombosis caused by EPN.

Case presentation: We report the case of a 52-year-old woman with past history of type 2 diabetes mellitus, presenting with loss of consciousness after vomiting for half a day. Abdominal computed tomography scan revealed unilateral EPN with air bubbles in the uterine veins. The blood, pus, and urine cultures were positive for extended-spectrum beta-lactamase-producing Escherichia coli. The patient's condition improved well after conservative management comprising supportive measures, broad-spectrum antibiotics, percutaneous drainage therapy, and an open operation.

Conclusions: Venous air bubbles are rare but fatal complication of EPN. Early diagnosis and treatment are critical to ensure good results.

Keywords: Emphysematous pyelonephritis; Escherichia coli; Pathogenesis; Treatment; Venous gas.

Fig. 1

Images in 53-year-old female with emphysematous pyelonephritis (EPN) of the left kidney. A, B Axial and volume-rendered abdominal CT shows the presence of gas in the parenchyma, para-renal space and left ureteral upper and middle part (white arrow). C, D Axial and multiplanar reconstruction in minimum-intensity projection CT shows air bubbles in the uterine vein (blue arrow)

Fig. 2

The follow-up computed tomography scan. A, B Abdominal and pelvic CT taken 3 days after open drainage show reducing of gas the uterine vein and in the left kidney (white arrow). C The 3-month follow-up abdominal CT shows complete absence of gas and shrunk-volume in the left kidney (blue arrow)