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February 21, 1977

Renal and Perirenal Gas in a Diabetic Man

JAMA. 1977;237(8):801-802. doi:10.1001/jama.1977.03270350061028

History  A 64-year-old diabetic man experienced back pain, fever, chills, and dyspnea for one week. On examination, his rectal temperature was 38 C; pulse rate, 120 beats per minute; and respiratory rate, 30/min. He had distended neck veins, a ventricular gallop, dullness to percussion at the base of each lung, peripheral edema, and tenderness in his right flank.Total leukocyte count was 19,900/cu mm; blood glucose concentration, 319 mg/100 ml; and BUN level, 88 mg/100 ml. Urine gave a 1 + glucose reaction and contained 70 to 100 WBCs and numerous bacilli per high power field. Cultures of blood and urine grew Escherichia coli. Roentgenographic studies include a chest film (Fig 1) and anteroposterior and lateral abdominal films (Fig 2 and 3).

Diagnosis  Emphysematous pyelonephritis with perinephric abscess and emphysematous cystitis.

Comment  The chest film depicts pulmonary vascular congestion, bilateral pleural effusions, infiltrates in both lower lobes, and gas partially outlining