A 46-year-old woman with no relevant history presents to the emergency department with severe right flank pain of 12 hours' duration. She also reports chills, nausea, and feeling feverish.
On examination:
The patient now reports that the pain began suddenly, was initially very intense and colicky, and radiated to the right groin.
A non-contrast CT is performed.
Report
8 mm stone in the proximal right ureter, with associated pelvicalyceal and proximal ureteral dilation.
The patient remains febrile and tachycardic.
A double-J stent is placed and empirical intravenous antibiotic treatment is started.
At 48 hours
Urine culture
Escherichia coli, with antibiogram available.
The patient improves and the infection is controlled.
Core concept
Pyelonephritis + obstruction = urological emergency.