A real pain in the back...or maybe not- a case series of urosepsis due to obstructing calculi identified on ultrasound

A real pain in the back...or maybe not- a case series of urosepsis due to obstructing calculi identified on ultrasound

Urosepsis, Point of care ultrasound, Hydronephrosis

Abstract
Background Urosepsis, due to obstructing urinary calculi, is a urologic emergency requiring surgical decompression
to reduce mortality. Presenting symptoms include fevers, pain, and dysuria, however, symptoms may be difficult to
assess in patients with shock and altered mental status. Point-of-care ultrasound (POCUS) is an invaluable tool to
assess patients in the emergency department (ED) with undifferentiated shock. We present a case series of three
patients presenting with septic shock, who were found to have hydronephrosis on POCUS, from an infected ureteral
stone.
Case presentation Three elderly patients presented to the ED with sepsis secondary to an infected kidney stone.
POCUS identified hydronephrosis leading to the diagnosis of infected ureteral stone as the nidus of the infection.
These patients presented with atypical symptoms, and POCUS was essential to making the diagnosis and rapid source
control.
Conclusion POCUS is a useful tool for evaluating patients with shock in the ED. Numerous ultrasonographic
protocols have been created to evaluate patients with shock, however, none of these include the importance
of evaluating for hydronephrosis. This case series highlights the importance of renal ultrasound in patients with
undifferentiated septic shock.
Keywords Urosepsis, Point of care ultrasound, Hydronephrosis

Aurora Jin1
, John Forrester1

, Nicholas Bielawa1

, Stephanie Jose1
, Vidhi Rao1
, James Napolitano1

, Elizabeth Young1
,

Mathew Nelson1*, Sofie Nelson1

and Allison Cohen1

2025

Peri Irawan

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