Abstract
Diagnosing acute pyelonephritis relies on the combination of historical, physical, and laboratory findings. Costovertebral angle tenderness is important, although its accuracy is unknown. Point-of-care ultrasound-guided palpation (sonopalpation) may aid clinicians in localizing pain to discrete anatomic structures in cases of suspected acute pyelonephritis lacking classic features. We describe three low-to-moderate pre-test probability cases wherein maximal tenderness was elicited by renal sonopalpation, aiding in the diagnosis of acute pyelonephritis. In a fourth case, absence of renal tenderness to sonopalpation in a patient exhibiting typical acute pyelonephritis features led to an alternate diagnosis. Therefore, renal sonopalpation may be useful in confirming or refuting suspected cases.
Highlights
Case 1 A 21-year-old woman with a past medical history of one uncomplicated urinary tract infection with a pan-sensitive urine culture presented to the emergency department (ED) with 2 days of new right-sided abdominal pain, noting some radiation to back
We describe a series of three patients with acute pyelonephritis where costovertebral angle tenderness was equivocal, but sonopalpation definitively localized maximal pain and tenderness to the kidneys
In a fourth patient in which acute pyelonephritis was initially suspected, nontender kidney sonopalpation eventually led to an alternative diagnosis
Summary
We describe a series of three patients with acute pyelonephritis where costovertebral angle tenderness was equivocal, but sonopalpation definitively localized maximal pain and tenderness to the kidneys. In a fourth patient in which acute pyelonephritis was initially suspected, nontender kidney sonopalpation eventually led to an alternative diagnosis. Case 1 A 21-year-old woman with a past medical history of one uncomplicated urinary tract infection with a pan-sensitive urine culture presented to the emergency department (ED) with 2 days of new right-sided abdominal pain, noting some radiation to back.
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