RENAL EMPHYSEMA

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Abstract
Review of the previously reported 27 cases and our own case of renal emphysema emphasizes that this is a roentgenologic diagnosis of a medical-surgical emergency which at the present time still carries a 55 per cent mortality. Typically, the patient is a diabetic female past middle age, in good metabolic control, sometimes with a previous history of coliform urinary tract infections. The illness is acute, usually less than 3 days in duration at the time of diagnosis, and the patient frequently presents with gram-negative sepsis. The earliest roentgenographic signs are a diffuse mottling of the renal parenchyma by hydrogen and carbon dioxide filled abscesses which are often radially distributed. As the infection spreads through the cortex, the gas extends beyond the renal capsule and is contained by Gerota's fascia, producing a crescentic margin or complete outlining of the kidney. Occasionally the infection and gas spread from the perirenal fascia into the retroperitoneal space. The best method for evaluating the uncertain case seems to be nephrotomography which should be performed as soon as possible so that immediate surgical and medical treatment may be started.

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