Thursday, December 9, 2010

Windowing Your CT

A 70 year old woman with diabetes presents with fevers, chills, flank pain, abdominal pain, nausea, and vomiting over the last week. Labs show hyperglycemia, leukocytosis, acute renal failure, and pyuria.

Imaging is shown above. Panel A is an abdominal radiograph. Panel B is a CT scan in soft tissue window. Panel C is an air window.

Challenge: What are the two most likely organisms that cause this disease?

Image is shown under Fair Use.

5 comments:

Marianne DiNapoli said...

E.coli and Staph saprophyticus?

Craig Chen said...

I'm having trouble with my internet, but answering coming soon, I promise!

Easy said...

Escherichia coli, enterococci, Pseudomonas aeruginosa, candida, and Klebsiella pneumoniae.

Craig Chen said...

hi! my internet is still giving me grief, but briefly, the diagnosis is emphysematous pyelonephritis and the most common organisms are E coli and Klebsiella. :)

Craig Chen said...

Windowing Your CT

The imaging shows abnormal collection of air around the right kidney. This is emphysematous pyelonephritis, a gas-producing necrotizing infection of the renal parenchyma or perirenal tissue, usually due to E.coli or Klebsiella (rarely Candida).

Sources: UpToDate; nature.com.