Perirenal Fluid Collection: An Uncommon Cause of Septic Shock

Abstract

An 83-year-old woman was brought by ambulance to the Emergency Department (ED) with worsening dyspnea, hypotension, fever, and diffuse abdominal pain for 2–3 days. Her past medical history was significant for vascular dementia. She was a resident in a nursing home institution. She was taking no medications. Upon arrival at the ED, the patient was unresponsive, hemodynamically unstable, and febrile. Vital signs were: heart rate 130 beats/min, right arm blood pressure 80/55 mm Hg, temperature 39 C (102.2 F), and respiratory rate 30 breaths/min. Oxygen saturation was 92% on room air. The physical examination revealed abdominal tenderness in the upper-right quadrant with no rebound and normoactive bowel sounds. There were no palpable mass lesions or renal bruits. The lung sounds were clear and symmetrical with no wheezes or crackles. The heart sounds were regular but tachycardic and without murmurs. Femoral pulses were thready and equal. The