Unusual Emphysematous Chest Wall with Progressive Loculated Empyema and Abscess Formation Post Emphysematous Pyelonephritis

Document Type : Case Report


1 Aja University of Tehran Medical Sciences, Tehran, Iran

2 Islamic Azad University of Tehran Medical Sciences

3 Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran



The abdominal emphysematous pyelonephritis and its association with lung involvement in diabetic patients can be life treating and should be cure as soon as possible. Our case is a 39-year-old female patient with diabetes mellitus with a history of left kidney stones. She underwent of with extracorporeal shock wave Lithotripsy (ESWL) and a week later referred to the emergency room because of glucose 389 mg/dL (milligrams per deciliter), fever and renal abscess. The infection then developed as emphysema around the kidneys and lungs and in subsequent studies of urine sample test confirmed the infection with E-Coil. Following this parenchymal infection, the left kidney was destroyed and developed above the abscess diaphragm, and the left lung collapsed causing Progressive Emphysematous (PELE). The patient underwent the necessary diagnostic and therapeutic measures, including glycemic control and surgery thoracoabdominal incision with left nephrectomy, abscess drainage and decortications. Eventually the patient was discharged with good general condition.