IMAGES IN EMERGENCY MEDICINE
Outlined psoas muscle shadow
Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan, Republic of China
Correspondence to:
Dr Shi-Jye Chu, Department of Emergency Medicine, Tri-Service General Hospital, 325, sec.2, Cheng-Kung Rd, Neihu 114, Taipei, Taiwan, Republic of China; d1204812@mail.ndmctsgh.edu.tw
Accepted 8 September 2006
| The first 150 words of the full text of this article appear below. |
A 54-year-old man presented with low back discomfort, weakness and fever (38.2°C). He had a history of alcohol-related cirrhosis of the liver and poorly controlled type 2 diabetes mellitus. A plain abdominal radiograph showed a crescentic collection of air surrounding the right renal fossa, air in the urinary bladder, and the psoas muscles clearly outlined by the free retroperitoneal air (fig 1, arrows). Subsequent unenhanced computed tomography of the abdomen confirmed the diagnosis of emphysematous pyelonephritis (EPN) as well massive gas in the bilateral retroperitoneal space and pelvis. He was treated conservatively with intravenous meropenum and percutaneous drainage. Cultures of blood and urine grew Klebsiella pneumoniae. The patient recovered uneventfully and was discharged on the 17th day after admission.
Figure 1 Plain abdominal radiograph showing a crescentic collection of air surrounding the right renal fossa, air in the urinary bladder, and the psoas muscles clearly outlined by the free | |||||||||
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