Diabetes, Fever and Flank Pain: Is it Emphysematous Pyelonephritis?

Fever and flank pain in a diabetic patient should raise the suspicion of emphysematous pyelonephritis (EPN). The clinical course of EPN can be severe and life threatening, if not recognized and treated promptly. Gas shadows in the renal or perirenal region on plain X-ray, ultrasound, or computed tomography (CT) scan of the abdomen are the radiological features of EPN. However, CT scan of the abdomen is sine qua non for classification, treatment options, and prognosis.