Faust Jeremy S, Tsung James W
Department of Emergency Medicine, Harvard Medical School, Brigham and Women's Hospital, 10 Vining Street, Neville House, Boston, MA, 02115, USA.
Department of Emergency Medicine and Division of Emergency Ultrasound, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA.
Crit Ultrasound J. 2017 Dec;9(1):1. doi: 10.1186/s13089-016-0056-6. Epub 2017 Jan 3.
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.
急性肾盂肾炎的诊断依赖于病史、体格检查和实验室检查结果的综合判断。肋脊角压痛很重要，尽管其准确性尚不清楚。即时超声引导下触诊（超声触诊）可能有助于临床医生在疑似急性肾盂肾炎但缺乏典型特征的病例中，将疼痛定位到离散的解剖结构。我们描述了三例预检概率低至中等的病例，其中通过肾脏超声触诊引出了最大压痛，有助于急性肾盂肾炎的诊断。在第四例病例中，一名表现出典型急性肾盂肾炎特征的患者经超声触诊未发现肾脏压痛，从而得出了另一种诊断结果。因此，肾脏超声触诊可能有助于确诊或排除疑似病例。
