Published online Apr 16, 2021. doi: 10.12998/wjcc.v9.i11.2584
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
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.
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.
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.