Echocardiogram: A Tool to Diagnose Emphysematous Pyelonephritis?! An interesting case

We present for the first time in the literature a 79-year-old patient with stage 4 chronic kidney disease and other comorbidities, who was admitted to the Nephrology Department complaining for weakness and fatigue. After positive blood cultures for Streptococcus gallolyticus development, an echocardiogram was performed searching the source of infection, that revealed air bubbles in right chambers, inferior vena cava and hepatic veins. A suspicion of emphysematous pyelonephritis was raised after that echo finding, and that was the diagnosis which a Computed Tomography of the abdomen and pelvis finally set. The patient was managed with broad-spectrum antibiotic therapy and a drainage using double-J ureteral catheter.