Emphysematous Pyelonephritis Presenting as Pneumaturia and the Use of Point-of-Care Ultrasound in the Emergency Department

Emphysematous pyelonephritis (EPN) is a rare form of pyelonephritis causing a severe infection of the renal system that includes gas in the renal parenchyma, collecting system and surrounding tissue often presenting with sepsis. We report the case of a 60-year-old male with poorly controlled insulin...

Full description

Saved in:
Bibliographic Details
Published in:Case reports in emergency medicine 2019-01, Vol.2019 (2019), p.1-5
Main Authors: Newberry, Mark, Kinas, David, Petersen, Paul, Brown, Natasha
Format: Article
Language:English
Subjects:
Abdomen
Antibiotics
Bacterial infections
Bladder
Case Report
Case reports
CT imaging
Diabetes
Diabetes therapy
Diagnosis
E coli
Emergency medical care
Emergency medicine
Emergency service
Health aspects
Hospitals
Infection
Infections
Medical diagnosis
Pain
Pathogenesis
Patients
Pyelonephritis
Sepsis
Tazobactam
Ultrasonic imaging
Urogenital system
Urology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Emphysematous pyelonephritis (EPN) is a rare form of pyelonephritis causing a severe infection of the renal system that includes gas in the renal parenchyma, collecting system and surrounding tissue often presenting with sepsis. We report the case of a 60-year-old male with poorly controlled insulin dependent diabetes mellitus who presented with abdominal pain, nausea, vomiting, and “peeing air.” CT scan revealed air extending from the left renal parenchyma, perinephric fat and into the bladder, consistent with emphysematous pyelonephritis. Bedside point-of-care ultrasound (POCUS) subsequently revealed dirty shadowing and reverberation artifacts in the left kidney and the bladder consistent with gas in the urinary collecting system. By understanding the identifying artifacts seen with EPN, reflective shadow and reverberation artifact, the emergency physician may be alerted to the diagnosis sooner. Often this illness presents similarly to simple, acute pyelonephritis or undifferentiated sepsis. Therefore, POCUS allows for real time consideration of this condition while in the emergency department and thus prompter time to treatment.
ISSN:2090-648X
2090-6498
DOI:10.1155/2019/6903193