title: Eliciting renal tenderness by sonopalpation in diagnosing acute pyelonephritis.
abstract: Diagnosing acute pyelonephritis relies on the combination of historical, physical, and laboratory findings. Costovertebral angle tenderness is important, although its accuracy is unknown. Point-of-care ultrasound-guided palpation (sonopalpation) may aid clinicians in localizing pain to discrete anatomic structures in cases of suspected acute pyelonephritis lacking classic features. We describe three low-to-moderate pre-test probability cases wherein maximal tenderness was elicited by renal sonopalpation, aiding in the diagnosis of acute pyelonephritis. In a fourth case, absence of renal tenderness to sonopalpation in a patient exhibiting typical acute pyelonephritis features led to an alternate diagnosis. Therefore, renal sonopalpation may be useful in confirming or refuting suspected cases.
authors.affiliation: Department of Emergency Medicine, Harvard Medical School, Brigham and Women's Hospital, 10 Vining Street, Neville House, Boston, MA, 02115, USA. jsfaust@gmail.com.
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Faust
authors.affiliation: Department of Emergency Medicine and Division of Emergency Ultrasound, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Tsung
keywords: Emergency medicine; Point-of-care ultrasonography; Pyelonephritis; Sonopalpation