Emphysematous Pyelonephritis with Massive Renal Parenchymal Gas and Fluid Collection

A 76-year-old female patient with diabetes was referred to our hospital for evaluation of a 1-week history of left abdominal pain with loss of appetite. Laboratory data showed markedly elevated neutrophils. Abdominal X-ray showed massive gas and fluid collection in the left pararenal space, resembling an intestinal obstruction. Abdominal computed tomography revealed renal parenchymal gas and fluid and led to the correct diagnosis of emphysematous pyelonephritis. Based on these findings, this patient was immediately transferred to the intensive care unit. She underwent emergent nephrectomy and was discharged 28 days after surgery without complications.