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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 54-year-old man with poorly controlled diabetes that started 7 years ago&#44; was admitted to the emergency department with pain in the left iliac fossa and left renal fossa&#44; which started 8 days earlier&#44; as well as a fever and pain in the left leg&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The physical examination revealed an adequate mental state &#40;Glasgow index of 15 points&#41;&#59; however&#44; there was a noteworthy increase in volume and the presence of crepitations in the scrotum and in the entire lower left extremity&#44; as well as the abdominal wall&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Uncontrasted tomography showed hypodense images throughout the kidney&#44; which extended towards the lower extremity and the corresponding scrotum with gas &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 1</a>&#41; and were related to a class IIIB of the Huang-Tseng classification &#40;coronal slice of the tomography with no contrast medium that showed an unusual extension of gas in the emphysematous pyelonephritis&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">We drained the retroperitoneal collection and the leg&#59; however&#44; the patient presented torpid progression&#46; We therefore performed a nephrectomy and aggressive debridement&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patient was admitted to the intensive care unit and treated with broad-spectrum antibiotics&#44; fluid management&#44; blood glucose and electrolyte control and required hemodialysis&#46; The patient&#44; however&#44; remained 17 days in the intensive care unit without improvement in the septic shock and in-hospital complications&#44; which resulted in his death&#46;</p></span>"
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Medicine in Images
DOI: 10.1016/j.rceng.2018.03.013
Unusual presentation of emphysematous pyelonephritis with extension to the scrotum and leg
Presentación inusual de pielonefritis enfisematosa con extensión escrotal y pierna
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E.O. Piñón Solis
Corresponding author
eopinon@hotmail.com

Corresponding author.
, J. García Ramirez, J.F. Gil Garcia
Departamento de Urología, Centro Médico Adolfo López Mateos, Instituto de Salud del Estado de México, Toluca, Estado de México, Mexico

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