Case 27 - Backed Up
Author: Angus Perks Reviewer: Nish Cherian/Nick Mani
A 9 year old girl is brought in to the Emergency Department with fever and vomiting. She is known to have bilateral ureteric narrowing previously managed with a right sided JJ-stent that was removed 18 months prior.
She denies dysuria/urinary frequency/renal angle tenderness. A year ago the right kidney length was recorded as 90mm.
You decide to perform renal POCUS in ED as shown below: -
Clip Collection (Press right/Left to change the clips)
Clip 1- Longitudinal view right renal
Clip 2- Longitudinal view right renal with measurement
Clip 3- Longitudinal view right testicle with colour flow doppler
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Bilateral hydronephrosis, worse on the right, with the right kidney measuring 128mm in length.
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Right side Grade IV (severe) hydronephrosis due to the obvious significant cortical thinning, left side Grade II-III (moderate)
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Comparing the POCUS images with the previous US KUB from a year ago, it shows a very significant increase in right kidney length, with evident of moderate to severe bilateral hydronephrosis.
In the context of fever and vomiting, this should raise alarm bells for obstructive infective nephropathy requiring urgent urological intervention.
CASE RESOLUTION
XR or CT KUB was avoided all together in ED. IV antibiotics and fluid was started in ED, and the girl had an urgent right nephrostomy.
