Abstract
Background
Over the past decade, point-of-care ultrasound (POCUS) has been performed increasingly
in pediatric emergency medicine for a variety of indications. POCUS is a focused,
limited, goal-directed examination at the bedside performed and interpreted by a physician
trained in POCUS with the purpose of answering a specific question. Applying POCUS
for immediate evaluation of specific emergent complaints may allow for faster and
safer management of ill patients in the pediatric emergency department (ED).
Case Report
A 5-year-old female presented to the pediatric ED with fever, vomiting, and back pain.
Based on the real-time gray scale and color Doppler POCUS findings, a diagnosis of
an acute lobar nephronia (ALN) was made by a pediatric emergency physician and the
patient was admitted to the hospital before laboratory and urinalysis findings were
resulted. This case report illustrates how POCUS and knowledge of the sonographic
characteristics of an ALN were beneficial for shortening the time to decision for
admission, rapidly ruling out hydronephrosis (which may have required other interventions),
and conveying important information to the admitting team.
Why Should an Emergency Physician Be Aware of This?
Performing a kidney POCUS and knowing the sonographic characteristics of an ALN can
assist in its diagnosis, especially in patients where pyuria is absent. In addition,
performing a kidney POCUS in patients with a suspected upper urinary tract infection
may shorten the time to decision for admission and improve communication with the
pediatric admitting resident regarding diagnosis and indication.
Keywords
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References
- Bedside ultrasound maximizes patient satisfaction.J Emerg Med. 2014; 46: 46-53
- Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients.Crit Care Med. 2004; 32: 1703-1708
- The hand-held ultrasound examination for penetrating abdominal trauma.Am J Surg. 2004; 187: 660-665
- Emergency thoracic ultrasound in the differentiation of the etiology of shortness of breath (ETUDES): sonographic B-lines and N-terminal pro-brain-type natriuretic peptide in diagnosing congestive heart failure.Acad Emerg Med. 2009; 16: 201-210
- Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial.Ann Emerg Med. 2006; 48: 227-235
- Point-of-care ultrasonography.N Engl J Med. 2011; 364: 749-757
- Point-of-care ultrasound integrated into a staged diagnostic algorithm for pediatric appendicitis.Pediatr Emerg Care. 2018; 34: 109-115
- Evaluation of hypertrophic pyloric stenosis by pediatric emergency physician sonography.Acad Emerg Med. 2013; 20: 646-651
- Bedside limited echocardiography by the emergency physician is accurate during evaluation of the critically ill patient.Pediatrics. 2004; 114: e667-e671
- Effect of bedside ultrasound on management of pediatric soft-tissue infection.J Emerg Med. 2010; 39: 637-643
- Bedside ultrasonography to identify hip effusions in pediatric patients.Ann Emerg Med. 2010; 55: 284-289
- Pediatric emergency medicine point-of-care ultrasound: summary of the evidence.Crit Ultrasound J. 2016; 8: 16
- Emphysematous pyelonephritis: bedside ultrasound diagnosis in the emergency department.Clin Pract Cases Emerg Med. 2017; 1: 92-94
- The role of emergency ultrasound for evaluating acute pyelonephritis in the ED.Am J Emerg Med. 2011; 29: 721-724
- Ultrasound bladder wall thickness measurement in diagnosis of recurrent urinary tract infections and cystitis cystica in prepubertal girls.J Pediatr Urol. 2013; 9: 1170-1177
- Is acute lobar nephronia the midpoint in the spectrum of upper urinary tract infections between acute pyelonephritis and renal abscess?.J Pediatr. 2010; 156: 82-86
- Acute lobar nephronia: a review.Pediatrics. 1991; 87: 728-734
- Comparison of acute lobar nephronia and acute pyelonephritis in children: a single-center clinical analysis in southern taiwan.Pediatr Neonatol. 2015; 56: 176-182
- Effective ultrasonographic predictor for the diagnosis of acute lobar nephronia.Pediatr Infect Dis J. 2004; 23: 11-14
- Computed tomography—an increasing source of radiation exposure.N Engl J Med. 2007; 357: 2277-2284
- Projected cancer risks from computed tomographic scans performed in the United States in 2007.Arch Intern Med. 2009; 169: 2071-2077
- Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries.Lancet. 2004; 363: 345-351
- Estimated risks of radiation-induced fatal cancer from pediatric CT.AJR Am J Roentgenol. 2001; 176: 289-296
- Focal bacterial nephritis (lobar nephronia) in children.J Pediatr. 1996; 128: 850-853
- Acute focal bacterial nephritis in 25 children.Pediatr Nephrol. 2007; 22: 1897-1901
- Comparison of acute lobar nephronia and uncomplicated urinary tract infection in children.J Microbiol Immunol Infect. 2010; 43: 207-214
- Acute focal bacterial nephritis: diverse clinical presentations in pediatric patients.Pediatr Infect Dis J. 1988; 7: 346-349
- Effective duration of antimicrobial therapy for the treatment of acute lobar nephronia.Pediatrics. 2006; 117: e84-e89
- Acute lobar nephronia: a case report and literature review.J Emerg Med. 2014; 46: 624-626
- Ultraschaldiagnostik in Paediatrie und Kinderheikunde Lehrbuch und Atlas.Thieme, Stuttgart, Germany2005
- Urinary tract.in: Siegel M.J. Pediatric Sonography. 3rd edn. Lippincott Williams & Wilkins, Philadelphia2002: 385-473
- Acute focal nephritis: its true sonographic face.Isr Med Assoc J. 2007; 9: 729-731
- Acute pyelonephritis: comparison of diagnosis with 99mTc-DMSA, SPECT, spiral CT, MR imaging, and power Doppler US in an experimental pig model.Radiology. 2001; 218: 101-108
- Color Doppler sonography in pyelonephritis.Pediatr Radiol. 1992; 22: 422-425
- Power Doppler sonographic pattern of acute pyelonephritis in children: comparison with CT.AJR Am J Roentgenol. 1996; 166: 1451-1455
- The role of power Doppler ultrasonography in the diagnosis of acute pyelonephritis.Br J Urol. 1998; 81: 360-363
Article info
Publication history
Published online: June 28, 2019
Accepted:
April 22,
2019
Received in revised form:
April 5,
2019
Received:
September 7,
2018
Footnotes
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Identification
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