Giant Pyonephrosis Diagnosed Using POCUS in a Resource-Limited Setting

Pyonephrosis is a severe complication of hydronephrosis and can lead to the destruction of the renal parenchyma, sepsis, shock, and death. The clinical presentation is nonspecific, and 15% of patients are asymptomatic on presentation. In resource-limited settings, where Computed Tomography (CT) imaging is not available, point of care ultrasound (POCUS) plays an important role in evaluating kidney diseases in the emergency department (ED). In this case, a 36-year-old man presented to the ED with dyspnea, fever, abdominal pain, and abdominal distention in the area where an intra-abdominal tumor was reported. After ultrasound-guided aspiration, pyonephrosis was diagnosed. In the absence of other capable specialists, the emergency physician performed a percutaneous nephrostomy procedure, and eight liters of pus were removed. The patient improved significantly and was discharged from the ED with oral antibiotics and scheduled urology follow-up in the clinic.