Hydropneumonephroureter and emphysematous cystitis

A 64-year-old man presented to our emergency room due to hematuria, lower abdominal fullness and urinary frequency for 2 days. The patient had a past history of diabetic nephropathy in chronic kidney disease, Stage 4, and benign prostate hypertrophy status posttransurethral resection of the prostate. Laboratory tests showed an elevation of the white blood cell count and C-reactive protein, acute deterioration of renal functions, combined pyuria, hematuria and proteinuria in urine analysis. A plain radiograph disclosed unusual gas distribution over the paravertebral region (Figure 1A). The computerized tomography (CT) of the abdomen further revealed gas in the genitourinary tract (Figure 1B), air-fluid level over bilateral ureters and renal