Clinical Case Scenario
A 37-year-old woman with a history of type 2 diabetes mellitus arrived at the emergency department with a history of five days of worsening severe left upper quadrant abdominal pain that radiated to her left flank. She also reported fever, chills, nausea, vomiting, and general malaise. Upon arrival, her vital signs were a heart rate of 110 bpm and a axillary temperature of 39 °C. Physical examination revealed tenderness in her left costovertebral area, but her abdomen was not tender. Lab tests confirmed a urinary tract infection with a white blood cell count of 12,510 cells/mm3 and an increase in immature white blood cells. Additionally, the serum creatinine level of 5.71 mg/dL prompted the physician to perform a bedside Point-of-Care Ultrasound (POCUS) of the left kidney (figure 1) to check for urinary tract obstruction.
Figure 1: POCUS of the left kidney
(Case courtesy of Maulik S Patel, Radiopaedia.org, rID: 17283)
Which of the following POCUS findings would be most characteristic and concerning for acute emphysematous pyelonephritis?
