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{
    "pk": 967,
    "title": "A Case Report on Distinguishing Emphysematous Pyelitis and Pyelonephritis on Point-of-care Ultrasound",
    "subtitle": null,
    "abstract": "Introduction\n: Point-of-care ultrasound (POCUS) in the emergency department (ED) is being performed with increasing frequency. The objective of this study was to demonstrate how utilization of POCUS can help the emergency physician recognize emphysematous pyelitis (EP) and emphysematous pyelonephritis (EPN).  \nCase Report\n: A 60-year-old female presented to the ED with normal vital signs and intermittent left-sided flank pain that radiated to her groin. She also had a history of obstructive nephrolithiasis. Within 20 minutes of arrival she became febrile (101.2°Fahrenheit), tachycardic (114 beats per minute), tachypneic (21 breaths per minute), and had a blood pressure of 114/82 millimeters mercury. POCUS was conducted revealing heterogeneous artifact with “dirty shadowing” within the renal pelvis, which was strongly suggestive of air. The emergency physician ordered a computed tomography (CT) to confirm the suspicion for EP and started the patient on broad-spectrum antibiotics. The CT showed a 1.3-centimeter calculus and hydronephrosis with foci of air. The patient received intravenous antibiotics and had an emergent nephrostomy tube placed. Urine cultures tested positive for pan-sensitive \nEscherichia Coli\n. Urology was consulted and a repeat CT was obtained to show correct drainage and decreased renal pelvis dilation.\nConclusion\n: Distinctly different forms of treatment are used for EP and EPN, despite both having similar pathophysiology. In EP, air can be seen in the renal pelvis on POCUS, as in this case study, which distinguishes it from EPN. In the case of our patient, the use of POCUS was useful to aid in rapid differentiation between EP and EPN.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "point-of-care ultrasound"
        },
        {
            "word": "emphysematous pyelitis"
        },
        {
            "word": "emphysematous pyelonephritis"
        }
    ],
    "section": "Case Reports",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/9rk4b719",
    "frozenauthors": [
        {
            "first_name": "Proma",
            "middle_name": "",
            "last_name": "Mazumder",
            "name_suffix": "",
            "institution": "Touro University Nevada, School of Osteopathic Medicine, Henderson, Nevada",
            "department": "None"
        },
        {
            "first_name": "Fares",
            "middle_name": "",
            "last_name": "Al-Khouja",
            "name_suffix": "",
            "institution": "University of California, Irvine, School of Medicine, Irvine, California",
            "department": "None"
        },
        {
            "first_name": "John",
            "middle_name": "",
            "last_name": "Moeller",
            "name_suffix": "",
            "institution": "University of California, Irvine, Department of Emergency Medicine, Orange, California",
            "department": "None"
        },
        {
            "first_name": "Shadi",
            "middle_name": "",
            "last_name": "Lahham",
            "name_suffix": "",
            "institution": "University of California, Irvine, Department of Emergency Medicine, Orange, California",
            "department": "None"
        }
    ],
    "date_submitted": "2021-01-01T05:31:11+08:00",
    "date_accepted": "2021-01-01T05:31:11+08:00",
    "date_published": "2021-01-01T05:32:44+08:00",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/967/galley/715/download/"
        }
    ]
}