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Yang B, Zhong J, Yang Y, Xu J, Liu H, Liu J. Machine learning constructs a diagnostic prediction model for calculous pyonephrosis. Urolithiasis 2024; 52:96. [PMID: 38896174 PMCID: PMC11186887 DOI: 10.1007/s00240-024-01587-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024]
Abstract
In order to provide decision-making support for the auxiliary diagnosis and individualized treatment of calculous pyonephrosis, the study aims to analyze the clinical features of the condition, investigate its risk factors, and develop a prediction model of the condition using machine learning techniques. A retrospective analysis was conducted on the clinical data of 268 patients with calculous renal pelvic effusion who underwent ultrasonography-guided percutaneous renal puncture and drainage in our hospital during January 2018 to December 2022. The patients were included into two groups, one for pyonephrosis and the other for hydronephrosis. At a random ratio of 7:3, the research cohort was split into training and testing data sets. Single factor analysis was utilized to examine the 43 characteristics of the hydronephrosis group and the pyonephrosis group using the T test, Spearman rank correlation test and chi-square test. Disparities in the characteristic distributions between the two groups in the training and test sets were noted. The features were filtered using the minimal absolute value shrinkage and selection operator on the training set of data. Auxiliary diagnostic prediction models were established using the following five machine learning (ML) algorithms: random forest (RF), xtreme gradient boosting (XGBoost), support vector machines (SVM), gradient boosting decision trees (GBDT) and logistic regression (LR). The area under the curve (AUC) was used to compare the performance, and the best model was chosen. The decision curve was used to evaluate the clinical practicability of the models. The models with the greatest AUC in the training dataset were RF (1.000), followed by XGBoost (0.999), GBDT (0.977), and SVM (0.971). The lowest AUC was obtained by LR (0.938). With the greatest AUC in the test dataset going to GBDT (0.967), followed by LR (0.957), XGBoost (0.950), SVM (0.939) and RF (0.924). LR, GBDT and RF models had the highest accuracy were 0.873, followed by SVM, and the lowest was XGBoost. Out of the five models, the LR model had the best sensitivity and specificity is 0.923 and 0.887. The GBDT model had the highest AUC among the five models of calculous pyonephrosis developed using the ML, followed by the LR model. The LR model was considered be the best prediction model when combined with clinical operability. As it comes to diagnosing pyonephrosis, the LR model was more credible and had better prediction accuracy than common analysis approaches. Its nomogram can be used as an additional non-invasive diagnostic technique.
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Affiliation(s)
- Bin Yang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, 650101, China
| | - Jiao Zhong
- Department of Urology, The Second People's Hospital of Yibin City, No. 96, North Street, Yibin, 644000, China
| | - Yalin Yang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, 650101, China
| | - Jin Xu
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, 650101, China
| | - Hua Liu
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, 650101, China
| | - Jianhe Liu
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, 650101, China.
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Liu D, Liu J, Li Z, Ge C, Guo H, Song S, Li Z, Bai S. The association between renal pelvis urine density and the risk of severe infectious complications in patient with symptom-free hydronephrosis after shock wave lithotripsy: a multi-center prospective study. Urolithiasis 2024; 52:72. [PMID: 38683224 DOI: 10.1007/s00240-024-01572-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024]
Abstract
Finding reliable and easy-to-obtain predictors of severe infectious complications after shock wave lithotripsy (SWL) is a major clinical need, particular in symptom-free hydronephrosis. Therefore, we aim to prospectively investigate the predictive value of Hounsfield units (HU) in renal pelvis urine for the risk of severe infectious complications in patients with ureteral stones and symptom-free hydronephrosis after SWL. This multi-center prospective study was conducted from June 2020 to December 2023. The HU of renal pelvis urine was measured by non-enhanced computed tomography. The severe infectious complications included systemic inflammatory response syndrome, sepsis, and septic shock. Binary logistic regression models assessed the odds ratios (ORs) and 95% confidence intervals (CIs). Finally, 1,436 patients with ureteral stones were enrolled in this study. 8.9% (128/1,436) of patients experienced severe infectious complications after SWL treatment. After adjusting confounding variables, compared with the patients in the lowest renal pelvis urine density quartile, the OR (95% CI) for the highest quartile was 32.36 (13.32, 78.60). There was a positive linear association between the HU value of renal pelvis urine and the risk of severe infectious complications after SWL (P for trend < 0.001). Furthermore, this association was also observed stratified by age, gender, BMI, stone size, stone location and hydronephrosis grade (all P for interaction > 0.05). Additionally, the nonlinear association employed by restricted cubic splines is not statistically significant (nonlinear P = 0.256). The AUROC and 95%CI of renal pelvis urine density were 0.895 (0.862 to 0.927, P value < 0.001). The cut-off value was 12.0 HU with 78.59% sensitivity and 85.94% specificity. This multi-center prospective study demonstrated a positive linear association between HU in renal pelvis urine and the risk of severe infectious complications in patients with ureteral stones and symptom-free hydronephrosis after SWL, regardless of age, gender, BMI, stone size, stone location, and hydronephrosis grade. These findings might be helpful in the SWL treatment decision-making process.
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Affiliation(s)
- Dongmei Liu
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Junlong Liu
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Zheming Li
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Chengshan Ge
- The Fifth Hospital of Liaoyang City, Liaoyang, China
| | - Hongqiang Guo
- The Fifth Hospital of Liaoyang City, Liaoyang, China
| | - Shiyu Song
- Luhe Hospital of Yingkou City, Yingkou, China
| | - Zhenhua Li
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China.
| | - Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China.
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Yoo MJ, Pelletier J, Koyfman A, Long B. High risk and low prevalence diseases: Infected urolithiasis. Am J Emerg Med 2024; 75:137-142. [PMID: 37950981 DOI: 10.1016/j.ajem.2023.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 11/13/2023] Open
Abstract
INTRODUCTION Infected urolithiasis is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of infected urolithiasis, including presentation, diagnosis, and management in the emergency department based on current evidence. DISCUSSION Although urolithiasis is common and the vast majority can be treated conservatively, the presence of a concomitant urinary tract infection significantly increases the risk of morbidity, to include sepsis and mortality. Identification of infected urolithiasis can be challenging as patients may have symptoms similar to uncomplicated urolithiasis and/or pyelonephritis. However, clinicians should consider infected urolithiasis in toxic-appearing patients with fever, chills, dysuria, and costovertebral angle tenderness, especially in those with a history of recurrent urinary tract infections. Positive urine leukocyte esterase, nitrites, and pyuria in conjunction with an elevated white blood cell count may be helpful to identify infected urolithiasis. Patients should be resuscitated with fluids and broad-spectrum antibiotics. Additionally, computed tomography and early urology consultation are recommended to facilitate definitive care. CONCLUSIONS An understanding of infected urolithiasis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Michael J Yoo
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Jessica Pelletier
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT, Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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McArthur M, Patel M. A pictorial review of genitourinary infections and inflammations. Clin Imaging 2023; 104:110013. [PMID: 37918136 DOI: 10.1016/j.clinimag.2023.110013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/03/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023]
Abstract
Various infectious and inflammatory diseases affect the genitourinary system. This paper provides a review of multiple common and uncommon infectious and inflammatory conditions affecting the genitourinary system and some associated complications. These include acute infectious cystitis, emphysematous cystitis, acute pyelonephritis, emphysematous pyelonephritis, renal and perinephric abscesses, pyonephrosis, xanthogranulomatous pyelonephritis, epididymo-orchitis, vasitis, prostatitis, pelvic inflammatory disease, renal hydatid infection, renal tuberculosis, actinomycosis, Erdheim-Chester Disease, IgG4-Related Kidney Disease, urethritis and urethral strictures, ureteritis cystica, and genitourinary fistulas. Radiologists should be aware of these diseases' complications and management. Uncommon conditions must be considered when evaluating the genitourinary system.
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Affiliation(s)
- Mark McArthur
- University of California, Los Angeles, United States.
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Scaglione M, Masala S, Iacobellis F, Tonerini M, Sica G, Liguori C, Saba L, Tamburrini S. Imaging in Non-Traumatic Emergencies. Tomography 2023; 9:1133-1136. [PMID: 37368545 DOI: 10.3390/tomography9030093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
"Emergency" is a scenario that every medical professional must face since the first day of her/his career [...].
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Affiliation(s)
- Mariano Scaglione
- Radiology Department of Surgery, Medicine and Pharmacy, University of Sassari, Viale S. Pietro, 07100 Sassari, Italy
- Department of Radiology, James Cook University Hospital & Teesside University, Marton Road Marton Rd., Middlesbrough TS4 3BW, UK
| | - Salvatore Masala
- Radiology Department of Surgery, Medicine and Pharmacy, University of Sassari, Viale S. Pietro, 07100 Sassari, Italy
| | - Francesca Iacobellis
- Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Via Cardarelli 9, 80100 Napoli, Italy
| | - Michele Tonerini
- Department of Emergency Radiology, Cisanello Hospital, Via Cisanello, 56124 Pisa, Italy
| | - Giacomo Sica
- Department of Radiology, Monaldi Hospital, 80131 Naples, Italy
| | - Carlo Liguori
- Ospedale del Mare-ASL NA1 Centro, Via Enrico Russo, 11, 80147 Napoli, Italy
| | - Luca Saba
- Department of Medical Sciences, University of Cagliari, 09124 Cagliari, Italy
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Puia D, Gheorghinca S, Pricop C. Multiple Percutaneous Drainage of a Giant Pyonephrosis Caused by Urolithiasis: A Case Report. Cureus 2023; 15:e39684. [PMID: 37398788 PMCID: PMC10308315 DOI: 10.7759/cureus.39684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
The prevalence of kidney stones continues to rise in modern times. Undiagnosed and/or mistreated, it can result in suppurative kidney damage and, in rare instances, death from systemic infection. We present the case of a 40-year-old woman who presented to the county hospital for sleight left lumbar pain, fever, and pyuria for about two weeks. Ultrasound and CT scan revealed a giant hydronephrosis with no visible parenchyma, secondary to a stone in the pelvic-ureteral junction. Although a nephrostomy stent was placed, 48 hours later the purulent content was not evacuated completely. She was referred to a tertiary center, where two more nephrostomy tubes were placed to completely evacuate approximately 3 L of purulent urine. Three weeks later, after the inflammation parameters normalized, a nephrectomy was performed with good outcomes. A pyonephrosis urologic emergency can develop into septic shock, demanding rapid medical attention to prevent potentially fatal outcomes. In some circumstances, percutaneous draining of a purulent collection may not be sufficient to remove the whole purulent mass. Before nephrectomy, all collections must be removed with further percutaneous procedures.
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Affiliation(s)
- Dragos Puia
- Urology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, ROU
| | | | - Catalin Pricop
- Urology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, ROU
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Kumar LP, Khan I, Kishore A, Gopal M, Behera V. Pyonephrosis among Patients with Pyelonephritis Admitted in Department of Nephrology and Urology of a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2023; 61:111-114. [PMID: 37203981 PMCID: PMC10088997 DOI: 10.31729/jnma.8015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Indexed: 11/13/2023] Open
Abstract
INTRODUCTION Pyonephrosis is a severe complication of pyelonephritis leading to rapid progression to sepsis and loss of renal function resulting in nephrectomy. Early identification of pyonephrosis based on clinical or radiological characteristics amongst pyelonephritis is paramount. This study aimed to determine the prevalence of pyonephrosis among patients with pyelonephritis admitted to the Department of Nephrology and Urology of a tertiary care centre. METHODS This descriptive cross-sectional study was done in a tertiary care centre among patients with pyelonephritis from 1 July 2016 to 31 Jan 2021. Ethical approval was obtained from Institution Ethics Committee (Reference number: IEC/56/21). The available clinical, demographic and laboratory parameters were recorded from the hospital records in a predesigned proforma. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. RESULTS Among 550 pyelonephritis patients, the prevalence of pyonephrosis was 60 (10.9%) (8.3-13.5, 95% Confidence Interval). The mean age was 54.62±12.14 years, and 41 (68.33%) were males. The most common clinical symptom was flank pain with or without fever in 46 (76.66%) patients. Escherichia coli was the most common offending organism in 20 (33.33%). Ultrasonography showed classical echogenic debris with floaters and internal echoes in 44 (73.33%) patients. Double J stenting was successfully done in 44 (73.33%) patients. Percutaneous nephrostomy was done in the remaining 16 (26.66%) patients. CONCLUSIONS The prevalence of pyonephrosis in pyelonephritis is similar to previous studies done in similar settings. KEYWORDS pyelonephritis; pyonephrosis; kidneys.
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Affiliation(s)
| | - Irshad Khan
- Command Hospital Central Command, Lucknow, Uttar Pradesh, India
| | - Amit Kishore
- Command Hospital Central Command, Lucknow, Uttar Pradesh, India
| | - Manoj Gopal
- Department of Nephrology, INHS Asvini, Mumbai, Maharashtra, India
| | - Vineet Behera
- Department of Nephrology, INHS Asvini, Mumbai, Maharashtra, India
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Chen CC, Hsieh MS, Hu SY, Huang SC, Tsai CA, Tsai YC. Performance of Scoring Systems in Predicting Clinical Outcomes of Patients with Emphysematous Pyelonephritis: A 14-Year Hospital-Based Study. J Clin Med 2022; 11:jcm11247299. [PMID: 36555916 PMCID: PMC9788337 DOI: 10.3390/jcm11247299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
Background: Emphysematous pyelonephritis (EPN) is a rare but severe necrotizing infection causing there to be gas in the pelvicalyceal system, renal parenchyma, and perirenal or pararenal space. Physicians should attend to EPN because of its life-threatening septic complications. The overall mortality rate has been reported to be as high as 20−40%. In addition, most patients had diabetes mellitus (DM) and obstructive uropathy. The most common isolated microorganism is Escherichia coli. This study aims to analyze the risk factors and performance of scoring systems in predicting the clinical outcomes of patients with EPN. Materials and Methods: We collected the data of patients with EPN in this single hospital-based retrospective study from the electronic medical records of Taichung Veterans General Hospital between January 2007 and December 2020. Radiological investigations of abdominal computed tomography (CT) confirmed the diagnosis of EPN. In addition, we analyzed demographics, clinical characteristics, and laboratory data. Finally, we used various scoring systems to predict clinical outcomes. Results: A total of fifty patients with EPN, whose diagnoses were confirmed through CT, were enrolled in the study. There were 18 males (36%) and 32 females (64%), with a mean age of 64.3 ± 11.3 years. The in-hospital mortality rate was 16%. A DM of 34 (68%) patients was the most common comorbidity. Fever was the most common symptom, found in 25 (50%) patients. The Mortality in Emergency Department Sepsis (MEDS) score was 4.64 ± 3.67 for survivors and 14.25 ± 5.34 for non-survivors (p < 0.001). The National Early Warning Score (NEWS) was 3.64 ± 2.33 for survivors and 7.13 ± 4.85 for non-survivors (p = 0.046). The Rapid Emergency Medicine Score (REMS) was 5.81 ± 1.97 for survivors and 9.13 ± 3.87 for non-survivors (p = 0.024). Regarding performance of mortality risk prediction, the AUC of ROC was 0.932 for MEDS, 0.747 for REMS, and 0.72 for NEWS. Conclusions: MEDS, REMS, and NEWS could be prognostic tools for the prediction of the clinical outcomes of patients with EPN. MEDS showed the best sound performance. In those with higher scores in MEDS (≥12), REMS (≥10), and NEWS (≥8), we recommended aggressive management and appropriate antimicrobial therapy as soon as possible to reduce mortality. Further large-scale studies are required to gain a deep understanding of this disease and to ensure patient safety.
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Affiliation(s)
- Chun-Cheng Chen
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Ming-Shun Hsieh
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan 330, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Correspondence: (S.-Y.H.); (S.-C.H.); Tel.: +886-4-23592525 (ext. 3670) (S.-Y.H.); +886-4-247395955 (ext. 34121) (S.-C.H.); Fax: +886-4-23594065 (S.-Y.H.); +886-4-24714800 (S.-C.H.)
| | - Shih-Che Huang
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Lung Cancer Diagnosis and Treatment Research Center, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Correspondence: (S.-Y.H.); (S.-C.H.); Tel.: +886-4-23592525 (ext. 3670) (S.-Y.H.); +886-4-247395955 (ext. 34121) (S.-C.H.); Fax: +886-4-23594065 (S.-Y.H.); +886-4-24714800 (S.-C.H.)
| | - Che-An Tsai
- Division of Infectious Disease, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Yi-Chun Tsai
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
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The “Black Pattern”, a Simplified Ultrasound Approach to Non-Traumatic Abdominal Emergencies. Tomography 2022; 8:798-814. [PMID: 35314643 PMCID: PMC8938823 DOI: 10.3390/tomography8020066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background: A key issue in abdominal US is the assessment of fluid, which is usually anechoic, thus appearing “black”. Our approach focuses on searching for fluid in non-traumatic patients, providing a new, simplified method for point-of-care US (POCUS). Objective: Fluid assessment is based on a three-step analysis that we can thus summarize. 1. Look for black where it should not be. This means searching for effusions or collections. 2. Check if black is too much. This means evaluating anatomical landmarks where fluid should normally be present but may be abnormally abundant. 3. Look for black that is not clearly black. This means evaluating fluid aspects, whether wholly anechoic or not (suggesting heterogeneous or corpusculated fluid). Discussion: Using this simple method focused on US fluid presence and appearance should help clinicians to make a timely diagnosis. Although our simplified, systematic algorithm of POCUS may identify abnormalities; this usually entails a second-level imaging. An accurate knowledge of the physio–pathological and anatomical ultrasound bases remains essential in applying this algorithm. Conclusion: The black pattern approach in non -traumatic emergencies may be applied to a broad spectrum of abnormalities. It may represent a valuable aid for emergency physicians, especially if inexperienced, involved in a variety of non-traumatic scenarios. It may also be a simple and effective teaching aid for US beginners.
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Tamburrini S, Fiorini V, Lugarà M, Napodano G, Del Biondo D, Squame F, Sarti G, Quassone P, Coppola MG, Iannuzzi M, Di Stasio M, Shatalova O, Marano I, Cagini L. Nephrobronchial fistula a case report and review of the literature. Radiol Case Rep 2021; 16:3470-3477. [PMID: 34539942 PMCID: PMC8440951 DOI: 10.1016/j.radcr.2021.08.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/11/2021] [Indexed: 12/23/2022] Open
Abstract
Nephrobronchial fistula is an extremely rare complications of renal infections. We present a case of nephrobronchial fistula in a middle age immunocompetent woman who complained cough and weight loss, with underlying asymptomatic nephrolithiasis. She underwent a chest X-ray that showed left lower lobe infiltrate and abdominal ultrasound. Abdominal ultrasound showed a complicated pyonephrosis ; CT of chest-abdomen-pelvis with intravenous contrast was performed in order to stage and define the extension of the pathology. At CT, a suspected diagnosis of stage III xanthogranulomatous pyelonephritis complicated with pyonephrosis and a nephrobronchial fistula was formulated. A nephrostomy tube was placed, and the patient was treated with antibiotics. Follow up CT, performed after 15 days, showed the healing of the fistulous connection between the perinephric abscess and bronchi; the patient underwent nephrectomy with no airway complication during intubation. Histopathological diagnosis confirmed the presence on complicated xanthogranulomatous pyelonephritis.
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Affiliation(s)
| | - Valeria Fiorini
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Marina Lugarà
- Department of Internal Medicine, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Giorgio Napodano
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Dario Del Biondo
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Fiorenzo Squame
- Department of Nuclear Medicine, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Giuseppe Sarti
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Pasquale Quassone
- Department of Radiology, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | | | - Michele Iannuzzi
- Department of Anesthesiology and Intensive Care, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Mario Di Stasio
- Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Olena Shatalova
- Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Ines Marano
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Lucio Cagini
- Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
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Tamburrini S, Lugarà M, Saturnino PP, Ferrandino G, Quassone P, Leboffe S, Sarti G, Rocco C, Panico C, Raffaele F, Cesarano T, Iannuzzi M, Cagini L, Marano I. Pleural empyema secondary to nephropleural fistula in complicated pyonephrosis. Radiol Case Rep 2021; 16:2714-2718. [PMID: 34336076 PMCID: PMC8318834 DOI: 10.1016/j.radcr.2021.06.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 12/27/2022] Open
Abstract
Pleural empyema of extra pulmonary origin is uncommon and empyema secondary to a fistula between the urinary tract and thorax is extremely rare. We report a case of nephropleural fistula causing massive pleural empyema in a 64-year-old woman with a long history of urological problems, including nephrolitiasis and urinary tract infection. She was admitted with sepsis, fever, chills, tachypnea, productive cough and pyuria. At clinical examination, breath sounds were reduced over the left hemithorax. CT revealed a fistulous connection from the upper left calyceal group and the pleural space. Drainage of thoracic and perinephric collection was carried out, but nephrectomy and pleural decortication were required due to haemopurulent urine and decreased hemoglobin levels during the hospitalization. This case demonstrates the unusual and prolonged evolution of an obstructive hydroureteronephrosis complicated by pyonephrosis, culminating in retroperitoneal abscess that fistulized into the pleural space, leading to empyema.
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Affiliation(s)
- Stefania Tamburrini
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
- Corresponding author.
| | - Marina Lugarà
- Department of Internal Medicine, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | | | | | - Pasquale Quassone
- Department of Radiology, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Silvio Leboffe
- Department of Radiology, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Sarti
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Concetta Rocco
- Department of Radiology, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Claudio Panico
- Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Francesco Raffaele
- Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Teresa Cesarano
- Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Michele Iannuzzi
- Department of Anesthesiology and Intensive Care, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Lucio Cagini
- Department of Thoracic Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Ines Marano
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
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