Point-of-care ultrasound for the early diagnosis of emphysematous pyelonephritis: A case report and literature review

Table 1 Initial laboratory data consistent with sepsis

Variables	Results	Normal range
White blood cells	10.37 × 109/L	4-10 × 109/L
Percentage of neutrophils	81%	50%-70%
Hemoglobin	11.9 g/dL	11.5-15 g/dL
Platelets	69 × 109/L	100-300 × 109/L
Alanine aminotransferase	21 IU/L	9-50 IU/L
Aspartate aminotransferase	23 IU/L	15-40 IU/L
Total bilirubin	0.58 mg/dL	0.29-1.2 mg/dL
Creatinine	1.66 mg/dL	0.3-1.0 mg/dL
CRP	175.1 mg/L	0.068-8.2 mg/L
PCT	> 100 ng/mL	< 0.05 ng/mL
Glycosylated hemoglobin	9%	4%-6%
Urine white blood cells	325/μL	0-5/μL

CRP: C-reactive protein; PCT: Procalcitonin.

Table 2 Cases of emphysematous pyelonephritis diagnosed by point-of care ultrasound

Ref.	Age in yr	Sex	Diabetes/comorbidities	Class of EPN	Treatment strategy	Outcome	Location of gas on ultrasound	POCUS features
McCafferty et al[3], 2017	84	Woman	Diabetes/CKD/hypertension	Class 2	MM + nephrectomy	Recovered	Renal cortex	Hyperechoic focus/dirty shadowing
Stone et al[19], 2005	47	Woman	Diabetes	Class 3A	MM + nephrectomy	Death	Renal parenchyma	Echogenic foci/dirty shadowing
Peng et al[44], 2017	68	Woman	Diabetes	Class 3A	MM + nephrectomy	Recovered	Perirenal space	Poor delineation of the kidney
Koratala et al[45], 2019	22	Woman	Diabetes	NM	NM	NM	Renal parenchyma	Hyperechoic focus/dirty shadowing/B-lines
Brown et al[46], 2019	60	Man	Diabetes	Class 3A	MM + PCD + DBJ stenting	Recovered	Renal parenchyma/collecting system	A-lines

CKD: Chronic kidney disease; DBJ: Double-J catheter; EPN: Emphysematous pyelonephritis; MM: Medical management; NM: Not mentioned; PCD: Percutaneous drainage; POCUS: Point-of-care ultrasound.