Unusual presentation of emphysematous pyelonephritis with extension to the scrotum and leg

Piñón Solis, E.O.; García Ramirez, J.; Gil Garcia, J.F.

doi:10.1016/j.rceng.2018.03.013

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"apellidos" => "Gil Garcia" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Urología, Centro Médico Adolfo López Mateos, Instituto de Salud del Estado de México, Toluca, Estado de México, Mexico" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Presentación inusual de pielonefritis enfisematosa con extensión escrotal y pierna" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1247 "Ancho" => 950 "Tamanyo" => 119052 ] ] "descripcion" => array:1 [ "en" => "Evidence of gas in the left kidney, using tomography without contrast medium, as well as gas towards the scrotum and left leg coming from the left kidney (axial image)." ] ] ] "textoCompleto" => "A 54-year-old man with poorly controlled diabetes that started 7 years ago, was admitted to the emergency department with pain in the left iliac fossa and left renal fossa, which started 8 days earlier, as well as a fever and pain in the left leg.The physical examination revealed an adequate mental state (Glasgow index of 15 points); however, there was a noteworthy increase in volume and the presence of crepitations in the scrotum and in the entire lower left extremity, as well as the abdominal wall.Uncontrasted tomography showed hypodense images throughout the kidney, which extended towards the lower extremity and the corresponding scrotum with gas (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 1</a>) and were related to a class IIIB of the Huang-Tseng classification (coronal slice of the tomography with no contrast medium that showed an unusual extension of gas in the emphysematous pyelonephritis) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia>We drained the retroperitoneal collection and the leg; however, the patient presented torpid progression. We therefore performed a nephrectomy and aggressive debridement.The patient was admitted to the intensive care unit and treated with broad-spectrum antibiotics, fluid management, blood glucose and electrolyte control and required hemodialysis. The patient, however, remained 17 days in the intensive care unit without improvement in the septic shock and in-hospital complications, which resulted in his death." "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-03-07" "fechaAceptado" => "2018-03-19" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Piñón Solis EO, García Ramirez J, Gil Garcia JF. Presentación inusual de pielonefritis enfisematosa con extensión escrotal y pierna. Rev Clin Esp. 2018;218:498–499." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1247 "Ancho" => 950 "Tamanyo" => 119052 ] ] "descripcion" => array:1 [ "en" => "Evidence of gas in the left kidney, using tomography without contrast medium, as well as gas towards the scrotum and left leg coming from the left kidney (axial image)." ] ] 1 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1093 "Ancho" => 950 "Tamanyo" => 107590 ] ] "descripcion" => array:1 [ "en" => "Coronal slice of the tomography without contrast medium showing an unusual extension of gas in the emphysematous pyelonephritis, which started from the parenchyma and perirenal space dissecting the retroperitoneal space and extending towards the left leg." ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000021800000009/v2_201811290638/S2254887418300754/v2_201811290638/en/main.assets" "Apartado" => array:4 [ "identificador" => "71811" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Medicine in images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021800000009/v2_201811290638/S2254887418300754/v2_201811290638/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418300754?idApp=WRCEE"]

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Vol. 218. Issue 9.

Pages 498-499 (December 2018)

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