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January 23, 1978

Unusual Abdominal Gas Collection

Author Affiliations

From the Department of Radiology, University of California, San Diego, and the University Hospital, San Diego.

JAMA. 1978;239(4):347-348. doi:10.1001/jama.1978.03280310079028

History  A 54-year-old diabetic man had a fever for five days, decreasing mental status, and ketoacidosis. Pertinent laboratory data included the following values: WBC, 17,000/cu mm; blood glucose, 800 mg/dl; BUN, 49 mg/dl; and creatinine, 2.3 mg/dl. A spinal tap yielded purulent fluid from which Escherichia coli was cultured. Treatment with chloramphenicol was begun, but a temperature of 39 °C persisted. A urogram was performed two days later. Roentgenograms shown include a preliminary film of the abdomen (Fig 1) and a tomogram coned over the right renal area obtained immediately following injection of 100 ml of diatrizoate sodium and meglumine (Fig 2). There was normal excretion by the nonobstructed left kidney. Delayed films showed no excretion on the right.

Diagnosis  Emphysematous pyelonephritis with perinephric gas.

Comment  The preliminary film (Fig 1) shows a large reniform collection of gas distending the perirenal (Gerota) fascia. The tomogram (Fig 2) shows several smaller