Ultrasound Findings of Emphysematous Pyelonephritis: A Case Series

Emphysematous pyelonephritis (EP) is a severe complication of acute pyelonephritis caused by gas-producing bacteria, with high morbidity and mortality. Early recognition is essential, but the symptoms of EP are similar to those of severe acute pyelonephritis, complicating the diagnosis. Although computed tomography (CT) is the preferred diagnostic tool, its use is often limited in resource-constrained settings. Point-of-care ultrasound (POCUS) offers a rapid, accessible alternative for identifying signs of complicated pyelonephritis, including EP and obstructive pyelonephritis. Renal POCUS can be used to screen and risk stratify patients with severe acute pyelonephritis, optimizing CT use and reducing delays in diagnosing complications. We present cases from a hospital in Lima, Peru, illustrating how POCUS effectively facilitated the timely diagnosis and management of EP.