Snap diagnosisが可能かもしれない腹単：NEJMのimage

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Images in Clinical Medicine 

N Engl J Med 2014; 371:e34November 27, 2014

Emphysematous Pyelonephritis

Chih-Yen Chen, M.D.
Taipei Medical University, New Taipei City, Taiwan
Chi-Jen Chen, M.D.
Shuang Ho Hospital, New Taipei City, Taiwan

• A 67-year-old woman with diabetes and poor glycemic control who had recently been treated for pyelonephritis presented to the emergency department in septic shock. She had a 2-day history of fever, flank pain, lethargy, and confusion. Blood tests showed leukocytosis and hyperglycemia. Urinary microscopy revealed pyuria. A scout image was obtained with the use of unenhanced computed tomography. The image revealed extensive gas collection in the parenchyma and perinephric space of the left kidney (arrows) and the left renal vein, with corresponding hydronephrosis and hydroureter. These findings and her symptoms suggested emphysematous pyelonephritis. Immediate radical nephrectomy was performed. Escherichia coli was found on blood cultures, and a course of piperacillin–tazobactam was administered. Despite intraoperative perforation of the bladder, which required surgical repair, the patient had a good postoperative recovery and remained well after the completion of antibiotic treatment, with good glycemic control. Elevated tissue levels of glucose in patients with diabetes may create a more favorable environment for gas-forming bacteria.

最初に当ブログに登場したのはもっと派手な症例である。

 

 

 

 

 

 

 

 

 

キーワードは重症糖尿病である。

2009年7月25日土曜日

尿路系の気腫？？

さらには種々の臓器の危ない気腫として集めた・・・

2014年1月11日土曜日

気腫のコレクションにはこんなのもあります。