{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T17:38:32Z","timestamp":1789925912252,"version":"4.0.1"},"reference-count":11,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2018,7,14]],"date-time":"2018-07-14T00:00:00Z","timestamp":1531526400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Emphysematous pyelonephritis is a rare but life-threatening infection characterized by an accumulation of gas in the renal parenchyma. A high mortality rate was reported, and timely administration of broad-spectrum antibiotics for enteric gram-negative bacilli, such as Escherichia coli, Enterobacter, and Klebsiella pneumoniae, was recommended for improving the clinical outcome. Computed tomography is a useful tool for identifying gas accumulation within the perirenal space. Abdominal ultrasound and abdominal plain film are alternative options with lower accuracy rates. Here, we present the case of a 49-year-old male patient who presented with acute-onset progressive abdominal cramping pain and dysuria. Diffuse bilateral opacities over the lung field and a heterogeneous mass with air density in the abdomen were found on radiological examination. Multiple septic pulmonary emboli and emphysematous pyelonephritis were diagnosed using computed tomography. After emergency percutaneous nephrostomy and administration of broad-spectrum antibiotics, the patient was discharged in a stable condition and followed up at the outpatient department. This report also describes the clinical and imaging features of emphysematous pyelonephritis and highlights that early diagnosis and timely administration of broad-spectrum antibiotics may help avoid a potentially devastating outcome.<\/jats:p>","DOI":"10.3390\/jcm7070176","type":"journal-article","created":{"date-parts":[[2018,7,16]],"date-time":"2018-07-16T04:05:33Z","timestamp":1531713933000},"page":"176","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Septic Pulmonary Emboli or Pulmonary Metastasis in a Patient with Diabetes Mellitus?"],"prefix":"10.3390","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8773-1847","authenticated-orcid":false,"given":"Meng-Yu","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan"},{"name":"Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling-Chi","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan"},{"name":"Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Long","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan"},{"name":"Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yung-Hsiang","family":"Yeh","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua 500, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3773-9015","authenticated-orcid":false,"given":"Chia-Jung","family":"Li","sequence":"additional","affiliation":[{"name":"Research Assistant Center, Show Chwan Memorial Hospital, Changhua 500, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giou-Teng","family":"Yiang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan"},{"name":"Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1148\/radiographics.22.3.g02ma06543","article-title":"Emphysematous infections of the abdomen and pelvis: A pictorial review","volume":"22","author":"Grayson","year":"2002","journal-title":"Radiographics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1038\/nrurol.2009.51","article-title":"Current management of emphysematous pyelonephritis","volume":"6","author":"Pontin","year":"2009","journal-title":"Nat. Rev. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.asjsur.2013.01.003","article-title":"Emphysematous pyelonephritis: An 8-year retrospective review across four acute hospitals","volume":"36","author":"Tsu","year":"2013","journal-title":"Asian J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.4103\/1319-2442.139948","article-title":"Emphysematous pyelonephritis with air in the renal vein and septic emboli in the lungs: A rare presentation","volume":"25","author":"Yadav","year":"2014","journal-title":"Saudi. J. Kidney Dis. Transpl."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"129","DOI":"10.20344\/amp.8869","article-title":"Fulminant Emphysematous Pyelonephritis Secondary to Urothelial Neoplasia with Reno-Colic Fistula","volume":"31","author":"Elvas","year":"2018","journal-title":"Acta. Med. Port."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1148\/radiographics.16.2.8966288","article-title":"Genitourinary tract gas: Imaging evaluation","volume":"16","author":"Joseph","year":"1996","journal-title":"Radiographics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1148\/radiology.198.2.8596845","article-title":"Acute gas-producing bacterial renal infection: Correlation between imaging findings and clinical outcome","volume":"198","author":"Wan","year":"1996","journal-title":"Radiology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1111\/j.1464-410X.2010.09660.x","article-title":"Emphysematous pyelonephritis","volume":"107","author":"Ubee","year":"2011","journal-title":"BJU Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1001\/archinte.160.6.797","article-title":"Emphysematous pyelonephritis: Clinicoradiological classification, management, prognosis, and pathogenesis","volume":"160","author":"Huang","year":"2000","journal-title":"Arch. Intern. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1111\/iju.12244","article-title":"Emphysematous pyelonephritis: Clinical characteristics and prognostic factors","volume":"21","author":"Lu","year":"2014","journal-title":"Int. J. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e3573","DOI":"10.1097\/MD.0000000000003573","article-title":"Recommended Initial Antimicrobial Therapy for Emphysematous Pyelonephritis: 51 Cases and 14-Year-Experience of a Tertiary Referral Center","volume":"95","author":"Lu","year":"2016","journal-title":"Medicine (Baltimore)"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/7\/7\/176\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:12:14Z","timestamp":1760195534000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/7\/7\/176"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,14]]},"references-count":11,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2018,7]]}},"alternative-id":["jcm7070176"],"URL":"https:\/\/doi.org\/10.3390\/jcm7070176","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7,14]]}}}