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A case is presented of an E. Coli emphysematous pyelonephritis in a 66 year old female diabetic patient who presented systemic sepsis with positive hemoculture. Diagnosis was obtained thanks to X-ray and the patient had a favorable evolution after left nephrectomy. This is a rare kidney disease (123 described cases) which evolves with necrosis of renal parenchyma and gas formation which frequently expands to the perirenal space and/or to the collector system. It presents a high mortality which can decrease according to the promptness of diagnosis based on X-ray. Thirty eight literature cases of the last decade are reviewed evaluating the efficiency of image diagnostic measures and surgical performance.
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