BMJ Case Reports 2009; doi:10.1136/bcr.05.2009.1873
  • Unusual association of diseases/symptoms

Pneumomediastinum as first manifestation of emphysematous pyelonephritis in a patient who is non-diabetic

  1. Kai-Chun Cheng1,
  2. Tzu-Chieh Lin–,
  3. Yu-Tse Tsan1,2,
  4. Sung-Yuan Hu1,2,4,5,
  5. Lee-Min Wang1,2,6
  1. 1
    Department of Emergency Medicine, Taichung Veterans General Hospital, Taiwan, Republic of China
  2. 2
    Chung Shan Medical University, Taiwan, Republic of China
  3. 3
    National Taiwan University, Taiwan, Republic of China
  4. 4
    National Taichung Nursing College, Taiwan, Republic of China
  5. 5
    Jen-Teh Junior College of Medicine, Nursing and Management, Taiwan, Republic of China
  6. 6
    National Yang-Ming University, Taiwan, Republic of China
  1. Sung-Yuan Hu, song9168{at}
  • Published 14 July 2009


Emphysematous pyelonephritis (EPN) is a rare but life-threatening acute suppurative infection of the kidney, characterised by production of gas within the renal parenchyma, collecting system or perirenal tissue. It has a high mortality rate (70% to 90%), and the majority of patients have diabetes mellitus. The left kidney is most common involved and Escherichia coli is the most common pathogen. EPN complicated with pneumomediastinum (PM) has been reported in only four cases previously. Here, a case of PM as first manifestation of EPN in a non-diabetic 81-year-old man is reported. He had experienced back pain and abdominal fullness for 1 week. A plain radiograph, CT aortography and MRI confirmed the diagnosis of EPN complicated with PM. The patient died on the 22nd day of treatment with antibiotics of cefmetazole, gentamycin and metronidazole.


  • Competing interests: None.

  • Patient consent: Patient/guardian consent was obtained for publication.

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