Emphysematous pyelonephritis (EPN) is a rare, life-threatening infection, and misdiagnosis as uncomplicated pyelonephritis is potentially fatal. Point-of-care ultrasound (POCUS) is a valuable tool for evaluation of the kidneys in patients with septic shock and pyelonephritis. While used primarily to assess for the complication of obstruction and hydronephrosis, POCUS may also detect signs of EPN and prompt surgical consultation for nephrectomy. We present a case in which the emergency physician diagnosed EPN by POCUS in a patient with septic shock and pyelonephritis.

The mean duration of the examination was reduced from 9.1 to 3.4 min ( P<0.0001), the mean fluoroscopy time was reduced from 1.5 to 1.0 min ( P<0.0002) and the mean dose-area product was reduced from 27.4 to 17 cGy.cm(2).