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Lower limb restriction is usually due to any pathology affecting the joints or neurological causes. Emphysematous pyelonephritis is caused by gas-producing anaerobes and is one of the life-threatening diseases. It can extend into various fascial planes can be seen causing multiple ranges of symptoms. A 49-year-old male patient came with complaints of difficulty in extending the left lower limb for the past 1 month with associated left loin pain radiating to the left lower limb. Plain CT KUB shows features suggestive of bilateral emphysematous pyelonephritis with left retro-renal multi-loculated collection with extension of infection into anterior abdominal wall fascia and inferiorly into the left pelvic muscles and left thigh. Emphysematous pyelonephritis presenting as necrotizing fasciitis is a rare phenomenon. Patients with uncontrolled diabetes can clinically present with both these entities. Necrotizing fasciitis of the thigh leading to restriction of movement in the lower limb can sometimes be the cardinal clinical and odd presentation of emphysematous pyelonephritis.

Mrs. E. J. N is a 57-year-old Type II diabetic who presented to the emergency unit of internal medicine with a 1-week history of reduction in urine output and passage of foul-smelling urine with associated fever, nausea, vomiting, and right flank abdominal pain. This clinical case was diagnosed as emphysematous pyelonephritis with the help of ultrasonography. She recovered with medical therapy. This case highlights that aggressive medical management in severe cases may obviate the need for potentially dangerous surgical interventions in resource-limited settings.

Background Pulmonary hypoplasia (PH) and congenital lobar emphysema (CLE) are very rare congenital pulmonary anomalies in veterinary medicine. PH refers to the incomplete pulmonary development due to embryologic imbalance of bronchial development between the lung buds, while CLE is defined as alveolar hyperinflation due to bronchial collapse during expiration caused by bronchial cartilage dysplasia, external bronchial compression, and idiopathic etiology. CLE may develop into pulmonary blebs or bullae that may rupture and induce a spontaneous pneumothorax. There are no reports on concurrent PH and CLE in animals. Case presentation A 7-month-old castrated male Italian Greyhound weighing 5.5 kg presented with vomiting and acute onset of severe dyspnea without any previous history of disease. After emergency treatment including oxygen supplementation and thoracocentesis, plain radiology and computed tomography scanning were performed and lobar emphysema with multiple bullae in the left cranial lung lobe associated with tension pneumothorax was identified. Since the pneumothorax was not resolved despite continuous suction of intrathoracic air for 3 days, a complete lobectomy of the left cranial lung lobe was performed. The excised lobe was not grossly divided into cranial and caudal parts, but a tissue mass less than 1 cm in size was present at the hilum and cranial to the excised lobe. Postoperatively, the dog recovered rapidly without air retention in the thoracic cavity. Histopathologically, the mass was identified as a hypoplastic lung tissue with collapsed alveoli, bronchial dysplasia, and pulmonary arterial hypertrophy. Additionally, the excised lung lobe presented CLE with marked ectasia of alveoli, various blebs and bullae, and general bronchial cartilage dysplasia. According to gross and histopathologic findings, the dog was diagnosed with concurrent PH and CLE in the left cranial lung lobe. During 16 months of follow-up, the dog was well and without any respiratory problems. Conclusions This case report confirmed the clinical and histologic features of two different types of rare congenital pulmonary anomalies, PH and CLE, which occurred concurrently in a single lung lobe of a young dog. The condition was successfully managed with lobectomy.

Diagnosis of myocardial abscess without endocarditis is challenging, and a high index of clinical suspicion is fundamental for diagnosis. It should never be ruled out before TEE. And CT could be a helpful modality in case of emphysematous morphology.

Emphysematous Pyelonephritis (EP) is a rare necrotizing renal parenchymal infection characterised by gas within the kidney parenchyma. Management with emergency nephrectomy has transitioned to a graded medical, radiological intervention and surgical approach. We present a rare case of high-risk emphysematous pyelonephritis, outlining key high risk factors and demonstrating staggered care escalation within a rural Australian referral hospital.

We report the case of a 48-year-old man with ischemic stroke, diabetes and chronic renal failure admitted for fever with LUTS associated with nausea and vomiting.The physical examination showed a depressible abdomen, painful prostate on digital rectal examination.A biological inflammatory syndrome with diabetic ketoacidosis.The abdominopelvic CT scan confirmed the diagnosis by the presence of gas in the prostate,and the CBUE was positive for Enterobacter cloacae.The patient was treated with appropriate antibiotic therapy with transrectal aspiration of the prostate collection,but the evolution was marked by the worsening of the patient's condition leading to his death after two weeks of treatment.

In our study, we aimed to evaluate the results of patients who underwent lung volume reduction surgery with video-assisted thoracoscopic surgery due to diffuse or upper lobe limited emphysema.Patients who underwent lung volume reduction surgery (LVRS) for emphysema in our clinic between March 2015 and January 2020 were included in the study. The files of the patients were evaluated retrospectively. Age, gender, smoking history, hospitalization time, drain removal time, complications, and postoperative pulmonary function test values were evaluated in the patient records.Twenty-four of the patients were male and 2 were female. The average age was determined as 49.6. Twenty-six patients underwent 31 surgical procedures, 5 of which were bilateral. Twenty-seven of them were performed by videothoracoscopic LVRS. Preoperative mean forced expiratory volume in 1 s (FEVVolume reduction surgery is a treatment method that positively affects the natural course of emphysema in addition to quitting smoking and oxygen therapy. Patients with predominantly emphysema in the upper lobes, low exercise capacity, and appropriate FEVW pracy poddano analizie wyniki operacji zmniejszenia objętości płuc wykonywanej z wykorzystaniem wideotorakoskopii u pacjentów z rozedmą uogólnioną lub ograniczoną do górnego płata płuca.Do badania włączono pacjentów, u których przeprowadzono operacyjne zmniejszenie objętości płuc (LVRS) w naszej klinice od marca 2015 do stycznia 2020 r. Retro-spektywnej analizie poddano dokumentację medyczną pacjentów.wiek, płeć, palenie tytoniu w wywiadzie, czas hospitalizacji, czas trwania drenażu, powikłania, a także pooperacyjne wyniki badań czynności płuc.Analizowana grupa obejmowała 24 mężczyzn i 2 kobiety. Średni wiek pacjentów wynosił 49,6 roku. U 26 pacjentów wykonano łącznie 31 zabiegów chirurgicznych (5 zabiegów obustronnych). W 27 przypadkach zabiegi LVRS wykonano z wykorzystaniem wideotorakoskopii. Przedoperacyjna średnia wymuszona objętość wydechowa w 1 s (FEVOperacyjna redukcja objętości płuc, oprócz rzucenia palenia i tlenoterapii, jest metodą terapeutyczną, która korzystnie wpływa na naturalny przebieg rozedmy. Największe korzyści ze stosowania tej metody stwierdzono u chorych z rozedmą zlokalizowaną głównie w górnych płatach płuc, niską wydolnością wysiłkową i odpowiednimi wartościami FEV

To describe a case of naturally occurring pneumatosis intestinalis, pneumatosis coli and emphysematous hepatitis in a cat. A 9‐month‐old, indoors‐only, female spayed, domestic medium hair cat presented for vomiting, open‐mouth breathing and acute collapse. The initial physical examination identified moderate to severe hypothermia [35°C (95°F)], obtunded mentation, weak femoral pulses, tachycardia (heart rate 240 beats per min), pale pink mucous membranes and significant splenomegaly on abdominal palpation. Immediate diagnostics performed [packed cell volume and total solids (PCV, TS), venous blood gas and electrolytes] revealed severe anaemia (PCV 12%), hypoproteinaemia (TS = 2.2 g/dl), and severe metabolic acidosis (pH 6.956). Additional diagnostics performed included Feline Leukaemia Virus and Feline Immunodeficiency Virus testing (FeLV/FIV), complete blood count (CBC) with pathology review, serum biochemistry profile, prothrombin time (PT) and partial thromboplastin time (PTT), urinalysis, and abdominal radiographs. Abdominal radiographs were consistent with gas within hepatic and splenic veins and parenchyma, small intestinal walls and colonic wall. Due to the guarded prognosis, euthanasia was elected. Necropsy was performed and the most significant gross and histopathological findings included intra‐luminal and intra‐mural intestinal haemorrhage and vascular congestion with mild neutrophilic hepatitis, and marked hepatic periportal emphysema. Clostridium perfrigens and Escherichia coli were cultured from the bowel wall; no bacterial growth from the liver or spleen was identified. This case report describes idiopathic emphysematous hepatitis, with concurrent emphysema of the spleen and intestinal wall and intestinal haemorrhage. To the authors’ knowledge, this type of pathology in a feline patient has not been previously described.

Association of emphysematous pyelonephritis (EPN) with horseshoe kidney is rare. It is a life-threatening condition with variable mortality. Historically, the treatment consisted of early nephrectomy. One such patient managed conservatively by placement of percutaneous drainage (PCD) and appropriate antibiotic coverage, is reported. This patient responded well to the conservative approach of treatment by insertion of PCD under computed tomography guidance. Hence, insertion of PCDs is an effective way of treating EPN.

We report a case of cooccurrence of xanthogranulomatous and emphysematous pyelonephritis along with necrotizing fasciitis (NF) of scrotum and premium in a patient was nondiabetic and the history of kidney stones. This case a unique presentation of NF due to two pyelonephritis causing fournier gangrene. Surgical management and antibiotics provide an effective management of the disease.

We report a 53 year-old woman with type 2 diabetes mellitus and hypertension, presenting with progressive abdominal pain lasting three weeks, associated with lower abdominal swelling and fever. Clinical examination showed a large increase in abdominal volume, contraction of extracellular compartment, and signs of severe sepsis. Computed tomography showed an over-distended bladder with severe wall and luminal pneumatosis and bilateral hydronephrosis. The diagnosis was of emphysematous cystitis associated to hydronephrosis. Urine and blood cultures were positive for multi-susceptible Escherichia coli. Clinical evolution was favorable after 6 weeks of ceftriaxone and urinary catheter use. Emphysematous cystitis is a rare clinical entity, with an associated mortality of 7%. Known predisposing factors are older age, female gender and presence of diabetes. Microbiological agents most frequently involved are Escherichia coli and Klebsiella pneumoniae (80% of cases). Medical treatment is preferred and is based on urinary tract decompression with a bladder catheter, and prolonged broad spectrum antimicrobial therapy.

Solitary serous renal cysts are common but their suppuration is rare. Cystic infection is usually a complication of autosomal-dominant polycystic kidney disease (ADPKD). Indeed, they account for approximately 10% of causes for hospitalization in patients with adult polycystic kidney disease.1 Herein, we report an extremely rare case of an emphysematous infection of a solitary renal cyst. To the best of our knowledge, this is the eighth case of a gas-forming infection of a renal cyst being reported in the literature.2,3

Hydatid disease of the adrenal gland is uncommon. We present images and description a case of emphysematous hydatid cyst of the adrenal gland that had an unfavourable intraoperative outcome.

Alina Sorina Voica,1 Cristian Oancea,1 Emanuela Tudorache,1 Alexandru F Crisan,2 Ovidiu Fira-Mladinescu,1 Voicu Tudorache,1 Bogdan Timar3 1Department of Pulmonology, Victor Babeş University of Medicine and Pharmacy, 2Pulmonary Rehabilitation Center, Hospital of Pneumoftiziology and Infectious Diseases “Dr Victor Babeş”, 3Department of Biostatistics and Medical Informatics, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania Background/objective: Chronic obstructive pulmonary disease (COPD) is a respiratory disease that results in airflow limitation and respiratory distress, also having many nonrespiratory manifestations that affect both function and mobility. Preliminary evidence suggests that balance deficits constitute an important secondary impairment in individuals with COPD. Our objective was to investigate balance performance in two groups of COPD patients with different body compositions and to observe which of these groups are more likely to experience falls in the future.Methods: We included 27 stable COPD patients and 17 healthy individuals who performed a series of balance tests. The COPD patients were divided in two groups: emphysematous and bronchitic. Patients completed the activities balance confidence scale and the COPD assessment test questionnaire and afterward performed the Berg Balance Scale, timed up and go, single leg stance and 6-minute walking distance test. We analyzed the differences in the balance tests between the studied groups.Results: Bronchitic COPD was associated with a decreased value when compared to emphysematous COPD for the following variables: single leg stance (8.7 vs 15.6; P

Summary Objectives To report three cases of emphysematous prostatic abscess (EPA) and review the literature on this rare entity. Methods All relevant articles published in English over the last 50 years (1961–2011) were identified using a MEDLINE search for keywords ‘emphysematous prostatitis' and ‘emphysematous prostatic abscess'. A total of 12 patients were evaluated for their age, race, underlying disease, pathogens, diagnosis tool, treatment options, and clinical outcome. Results EPA is a high mortality disease (25%) and has an association with diabetes mellitus. The most common pathogen in the 12 cases was Klebsiella pneumoniae . Conclusions The mortality of EPA is higher than that of emphysematous cystitis and emphysematous pyelonephritis. Timely recognition and prompt drainage are very important.

Emphysematous Pyelonephritis (EPN) is a severe, necrotizing, life threatening infection of the renal parenchyma and management is not standardised due to scarcity of literature. We present 3 patients with this rare entity. All 3 patients were of class III on CECT findings based on Huang's classification and had more than two risk factors. Our first patient underwent percutaneous drainage of his condition upon which he recovered. The second and third patients underwent a laparotomy and nephrectomy. The second patient recovered after a stormy post operative period and the third patient died. Management of the first patient was contrary to that recommended in literature, for the other two it was as per recommendations. On successful management of our first patient without surgery and seeing no discernable benefits of surgery for our other two patients, it is possible that percutaneous drainage alone, coupled with antibiotics may be a viable strategy for managing this condition with nephrectomy being considered as a second tier option.

Objective: Emphysematous cholecystitis is a severe form of acute cholecystitis and can be rapidly fatal. We present the imaging features of nine patients with proven emphysematous cholecystitis.

Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the kidney characterized by the presence of gas in the renal parenchyma, collecting system or perinephric tissues. It can be life-threatening if not recognized and treated promptly. We report the case of a 56-year-old woman, on treatment for diabetes mellitus, who presented with left-sided flank pain and fever. Computerized tomography revealed EPN with extensive destruction of the left kidney. Intravenous antibiotics were administered and left nephrectomy was performed. The postoperative course was uncomplicated, but during 4months follow-up the patient's renal function rapidly deteriorated. This case report emphasizes the need for appropriate management of EPN.

Emphysematous pyelonephritis is a severe, acute necrotizing renal parenchymal and perirenal infection with formation of gas. Emphysematous pyelonephritis predominantly affects females with uncontrolled diabetes and can occur in insulin-dependent as well as non-insulin dependant patients. CT scan is the modality of choice for the staging of the parenchymal gas and to rule out obstruction. We present a case of 83-year old female with uncontrolled diabetes mellitus who presented with dysurea and right flank pain in the emergency department. She was diagnosed as a case of emphysematous pyelonephritis. She was treated successfully in the urology department by antibiotics and percutaneous drainage.

Renal Cyst infections are rare, account for approximately 10% of causes for hospitalization in patients with adult polycystic kidney disease. We reported a rare case of ruptured emphysematous renal cyst with infection extending into the right perinephric space with gas forming organism involving the renal collecting system and the urinary bladder.

Context: Emphysematous pyelonephritis (EPN) is an acute necrotizing inflammation of renal parenchyma and peri-nephric tissue characterized by gas formation. In this study, we evaluated the outcome of EPN cases by medical management with or without renal decompression. Materials and Methods: We have observed prospectively 15 cases of EPN admitted in our institute in respect to age, sex, mode of presentation, presence of comorbidity, laboratory profile, urine-analysis, and outcome after medical management and drainage procedures. Results: All patients improved on medical management and drainage procedure such as JJ stenting and percutaneous nephrostomy. No mortality noted in our 15 cases of EPN. Conclusion: Emphysematous pyelonephritis can be managed conservatively by DJ stenting, wcich is a less morbid procedure or percutaneous nephrostomy with proper antibiotics and adequate glycemic control.

A 62-yr-old woman with an autosomal dominant polycystic kidney disease (ADPKD) was admitted to our hospital for further evaluation of intermittent fever, nausea and left flank discomfort. The computed tomography (CT) scan revealed a gas-forming, infectious cyst of approximately 8.1 cm in size in left kidney lower pole. Escherichia coli was identified from the cyst fluid culture examination. Her symptoms improved only after the concomitant use of intravenous ciprofloxacin and an intracystic irrigation of ciprofloxacin through a percutaneous cystostomy drainage. Our case presents the successfully treated emphysematous cyst infection with combination of intravenous antibiotics and intracystic antibiotic therapy instead of surgical management.

SummaryWe report the case of a 15-year-old girl with pelvic and sacral emphysematous osteomyelitis caused by Fusobacterium necrophorum. This infection was cured following four surgical procedures and 4 weeks of intravenous then 4 weeks of oral antibiotics. We review our case alongside the 24 previously reported cases of emphysematous osteomyelitis in the literature. The 25 cases include 15 monomicrobial and 10 polymicrobial infections. The causative organism(s) in all but three cases included an anaerobe or a member of the Enterobacteriaceae family. A significant underlying comorbidity was reported in 18 cases. At least 15 cases required one or more surgical procedures. There was a significant associated mortality with eight (32%) patients dying in hospital at 7 to 56 days after the diagnosis of emphysematous osteomyelitis.

Prostatic abscess is an uncommon condition and clinical diagnosis is difficult. The classical symptoms and signs of prostatic abscess are variable and nonspecific. Here, we report a rare case of emphysematous prostatic abscess due to candidiasis in a 68-year-old man with diabetes and liver cirrhosis. The diagnosis was confirmed by pelvic computed tomography (CT) and successfully treated by antibiotics and CT-guided percutaneous abscess drainage. This case highlights the importance of early and accurate diagnosis of emphysematous prostatic abscess followed by appropriate treatment.

A 63-year-old woman presented with a 2-day history of nausea, vomiting and abdominal pain. She deteriorated rapidly with the development of anuric acute kidney injury and respiratory failure, requiring admission to the intensive care unit for CVVH and ventilation. Her past medical history included type 2 diabetes mellitus, treated with insulin therapy and a previous right nephrectomy (12 years previously) for a renal cell carcinoma. Her pre-admission serum creatinine was 89 μmol/l, but previous HbA1c readings of 14.5% indicated suboptimal glycaemic control. Initial investigations confirmed sepsis; Escherichia coli grown from blood cultures was treated with i.v. tazocin. An abdominal CT scan (Figures ​(Figures11 and ​and2)2) demonstrated a dilated left kidney with air in the renal parenchyma, typical of emphysematous pyelonephritis, staged as Class 4 [4]. A plain AXR also demonstrated air within the left kidney (Figure ​(Figure3).3). Treatment consisted of continuous i.v. antibiotics for 4 weeks and subsequently two percutaneous nephrostomies to facilitate drainage. Fig. 1 Axial CT scan demonstrating dilatation and gas within the left kidney. Fig. 2 Axial CT scan image of left kidney reveals emphysematous pyelonephritis. Fig. 3 Plain AXR demonstrating gas within the left kidney. Urine output improved following treatment, but 3 months later the patient remains dialysis dependent and continues to suffer from urinary tract infections. Emphysematous pyelonephritis is typically seen in female diabetic patients and E. coli is the commonest isolated organism [4]. Low oxygen tension within the kidney enforces anaerobic metabolism in E. coli, which are facultative anaerobes [2]. Gas production is secondary to rapid tissue catabolism with fermentation of glucose to carbon dioxide, which is not effectively transported away and remains localized at the site of inflammation. Further ischaemia results in tissue necrosis and perpetuates an environment for gas formation. The resulting appearances on imaging are dramatic. Management should include fluid resuscitation, glycaemic control, antibiotics and drainage [3], but nephrectomy is sometimes necessary. Following recovery of the acute episode, function of the affected kidney, as in this case, is often very poor [1]. Conflict of interest statement. None declared.

Emphysematous gastritis is a rare variant of gastritis that is characterised by the presence of gas in the wall of the stomach with CT scan being the procedure of choice for diagnosis. It is a potentially fatal disease that is caused by gas forming organisms and usually presents with systemic toxicity. Predisposing factors include corrosive ingestion, alcohol abuse, abdominal surgery, diabetes, and immunosuppressant. Antimicrobial therapy with antibiotics covering gram-negative organisms and anaerobes, and surgery in appropriate cases may enhance survival. We report a new case of emphysematous gastritis following pelvic surgery, diagnosed with a CT scan that showed gas in both stomach wall and liver portal venous distribution and recovered with conservative management.

Emphysematous epididymo-orchitis is a rare cause of an acute scrotum and is a surgical emergency. Diagnosis is clinically difficult, and sonography with a high-frequency probe is useful to pick up gas shadows in the scrotal wall or testicular substance. A diabetic patient presented with fever, urinary tract infection, and an acute scrotal swelling. The patient needed orchidectomy and scrotal debridement. As in emphysematous pyelonephritis, this condition occurs in diabetics, and patients may need surgery. There is a need to perform sonography in all diabetic patients with an acutely inflamed scrotum, because detection of gas shadows makes surgical intervention more likely.