case_images: PMC5843965_01
case_images: A 53-year-old female patient with emphysematous pyelonephritis with necrotizing fasciitis presented with breathlessness, pain in left lower hemithorax and in the left lumbar region. (a) Noncontrast axial computed tomography thorax in mediastinal window showing bilateral pleural effusion (white arrow), (b) Coronal high-resolution computed tomography window showing necrotizing fasciitis in the left lateral chest wall (black arrow).
case_images: JCIS-8-7-g002.jpg
case_images: PMC5843965_01_JCIS-8-7-g002.jpg
case_images: F1
case_images: Air foci were also noted in subcutaneous and intermuscular fat planes of anterior, left lateral, and posterior chest wall in the left mid and lower hemithorax extending into the left axilla [Figure 1].
case_images: A 53-year-old female patient with emphysematous pyelonephritis with necrotizing fasciitis presented with breathlessness, pain in left lower hemithorax and in the left lumbar region. Axial noncontrast computed tomography abdomen showing a well-defined hypodense abscess along anterolateral aspect of the left kidney (white arrow) with extension into perinephric space with multiple air foci within, extension of the abscess in left anterior pararenal space (curved white arrow), posterior to pancreatic body and tail, and a radio-opaque gallstone (black arrow).
case_images: JCIS-8-7-g003.jpg
case_images: PMC5843965_01_JCIS-8-7-g003.jpg
case_images: F2
case_images: A lamellated radiopaque gallstone of size 11 mm x 10 mm was noted [Figures 2-5].
case_images: A 53-year-old female patient with emphysematous pyelonephritis with necrotizing fasciitis presented with breathlessness, pain in left lower hemithorax and in the left lumbar region. Axial noncontrast computed tomography abdomen showing retroperitoneal abscess extending anterolateral to left psoas, anterior to left iliacus, extending up to left inguinal region with multiple air foci (white arrows). Multiple air foci just beneath anterior abdominal wall on either side, in intermuscular fat planes of abdominal wall muscles and in subcutaneous fat in anterior abdominal wall on the left side (curved white arrows).
case_images: JCIS-8-7-g004.jpg
case_images: PMC5843965_01_JCIS-8-7-g004.jpg
case_images: F3
case_images: A lamellated radiopaque gallstone of size 11 mm x 10 mm was noted [Figures 2-5].
case_images: A 53-year-old female patient with emphysematous pyelonephritis with necrotizing fasciitis presented with breathlessness, pain in left lower hemithorax and in the left lumbar region. Noncontrast computed tomography abdomen and pelvis (a: coronal and b: sagittal) showing left renal (white arrow) and retroperitoneal abscess with air foci (curved white arrow).
case_images: JCIS-8-7-g005.jpg
case_images: PMC5843965_01_JCIS-8-7-g005.jpg
case_images: F4
case_images: A lamellated radiopaque gallstone of size 11 mm x 10 mm was noted [Figures 2-5].
case_images: A 53-year-old female patient with emphysematous pyelonephritis with necrotizing fasciitis presented with breathlessness, pain in left lower hemithorax and in the left lumbar region. Noncontrast computed tomography thorax and abdomen with pelvis (a and b: mediastinal window - axial, c: coronal) showing necrotizing fasciitis in the left lateral chest wall up to left axilla (black arrow), along left lateral abdominal wall (white arrow) reaching up to perivesical fat (curved white arrow).
case_images: JCIS-8-7-g006.jpg
case_images: PMC5843965_01_JCIS-8-7-g006.jpg
case_images: F5
case_images: A lamellated radiopaque gallstone of size 11 mm x 10 mm was noted [Figures 2-5].
case_images: A 53-year-old female patient with emphysematous pyelonephritis with necrotizing fasciitis presented with breathlessness, pain in left lower hemithorax and in the left lumbar region. Noncontrast computed tomography abdomen and pelvis showing pigtail catheterization in a retroperitoneal abscess (white arrow).
case_images: JCIS-8-7-g007.jpg
case_images: PMC5843965_01_JCIS-8-7-g007.jpg
case_images: F6
case_images: Drainage of the abscess with pigtail catheter revealed Klebsiella pneumoniae on culture studies [Figure 6].