Xing ZX, Yang H, Zhang W, Wang Y, Wang CS, Chen T, Chen HJ. Point-of-care ultrasound for the early diagnosis of emphysematous pyelonephritis: A case report and literature review . World J Clin Cases 2021; 9(11): 2584-2594 [PMID: 33889624 DOI: 10.12998/wjcc.v9.i11.2584]
Corresponding Author of This Article
Hua-Jun Chen, MD, Associate Professor, Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Huichuan District, Zunyi 563000, Guizhou Province, China. 1308732019@qq.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Apr 16, 2021; 9(11): 2584-2594 Published online Apr 16, 2021. doi: 10.12998/wjcc.v9.i11.2584
Point-of-care ultrasound for the early diagnosis of emphysematous pyelonephritis: A case report and literature review
Zhou-Xiong Xing, Hang Yang, Wen Zhang, Yu Wang, Chang-Sheng Wang, Tao Chen, Hua-Jun Chen
Zhou-Xiong Xing, Wen Zhang, Yu Wang, Chang-Sheng Wang, Tao Chen, Hua-Jun Chen, Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Hang Yang, Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Author contributions: Xing ZX reviewed the literature, and contributed to manuscript drafting; Yang H, Zhang W, and Wang CS performed the ultrasonography and contributed to manuscript drafting; Chen T and Wang Y drafted the manuscript; Chen HJ reviewed the literature and was responsible for the intellectual content of the manuscript; All authors issued final approval for the version to be submitted.
Supported byFoundation of Health Commission of Guizhou Province, No. gzwjkj2020-1-021.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hua-Jun Chen, MD, Associate Professor, Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Huichuan District, Zunyi 563000, Guizhou Province, China. 1308732019@qq.com
Received: December 14, 2020 Peer-review started: December 14, 2020 First decision: December 30, 2020 Revised: January 4, 2021 Accepted: February 9, 2021 Article in press: February 9, 2021 Published online: April 16, 2021 Processing time: 109 Days and 8.7 Hours
Abstract
BACKGROUND
Emphysematous pyelonephritis (EPN) is a rare but fatal necrotic infection of the kidney, which usually leads to septic shock. Therefore, early diagnosis and optimized therapy are of paramount importance. In the past two decades, point-of-care ultrasound (POCUS) has been widely used in clinical practice, especially in emergency and critical care settings, and helps to rapidly identify the source of infection in sepsis. We report a rare case in which a “falls” sign on POCUS played a pivotal role in the early diagnosis of EPN.
CASE SUMMARY
A 57-year-old man presented with fever and lumbago for 3 d prior to admission. He went to the emergency room, and the initial POCUS detected gas bubbles in the hepatorenal space showing a hyperechoic focus with dirty shadowing and comet-tail artifacts. This imaging feature was like a mini waterfall. His blood and urine culture demonstrated Escherichia coli bacteremia, and EPN associated with septic shock was diagnosed. The patient did not respond to broad-spectrum antibiotic treatment and a perirenal abscess developed. He subsequently underwent computed tomography-guided percutaneous catheter drainage, and fully recovered. We also review the literature on the sonographic features of POCUS in EPN.
CONCLUSION
This case indicates that a “falls” sign on POCUS facilitates the rapid diagnosis of severe EPN at the bedside.
Core Tip: Emphysematous pyelonephritis (EPN) is a rare but life-threatening infection, and its diagnosis and treatment remain challenging. Point-of-care ultrasound (POCUS) plays an important role in rapidly assessing critically ill patients at the bedside. Here, we report a “falls” sign on the initial POCUS examination in a patient diagnosed with EPN associated with septic shock. We suggest that the “falls” sign may act as an imaging feature for early diagnosis of EPN. The patient was successfully treated with computed tomography-guided percutaneous catheter drainage plus broad-spectrum antibiotic therapy.
