Submitted by Dr TANG Kam Shing on 10 June 2009; ICU, Tuen Mun Hospital
The patient was a 45-year-old man with known history of NIDDM, who had defaulted follow up at our hospital and was receiving medications from a mainland China hospital. He was admitted for very high glucose level and acidosis. Urine ketone was negative. Blood lactate was 8. Gram stain of blood showed Gram negative Bacilli. Bedside USG abdomen was done for deranged LFT. The following image of the right kidney was taken. What is the abnormality?
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Answer: The USG image of the right kidney showed irregular hyperechoic renal cortex. The posterior cortex of the kidney cannot be seen. The reason is gas in the renal parenchyma due to emphysematous pyelonephritis, which was confirmed with CT. Right nephrectomy was done and patient made an uneventful recovery.