Septic Pulmonary Emboli or Pulmonary Metastasis in a Patient with Diabetes Mellitus?

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.