We present a 76-year-old woman with hypertension, diabetes, and obesity, admitted to the emergency department with a one-week course of metrorrhagia and oligoanuria. She presented with tenderness at the hypogastrium where there was an irregular mass, with illdefined contours, reaching the umbilicus. Blood tests showed anemia (7.7 g/dL)and acute kidney injury (AKI) (urea 108 mg/dL, creatinine 2.7 mg/dL).

Point-of-care ultrasound (POCUS) was performed. Mild right hydronephrosis was noted raising the possibility of obstructive uropathy (Fig. 1). Bladder examination ensued showing a mass with 12x20 cm and no noticeable bladder contour (Fig. 2A).

Figure 1: Longitudinal view of the right kidney showing mild hydronephrosis (red arrows). The blue circle signals the transducer marker in the cranial direction. 

Figure 2: (A) Longitudinal view. Uterine mass is delimited by red arrows. (B) Longitudinal view. The image shows the urinary catheter balloon (green arrow) located in the bladder, and posteriorly a uterine mass (red arrows). The blue circle signals the transducer marker in the cranial direction. 

The use of POCUS allowed a timely referral to the Gynecologist. An abdominal-pelvic computed axial tomography was performed, and a biopsy ensued, revealing undifferentiated carcinoma of endometrial origin.

This case report demonstrates the usefulness of POCUS as a real time diagnostic exam which can assist therapeutic interventions.^1,2POCUS allowed a dynamic approach: an obstructive mass was identified, a urinary catheter was placed, and visualization of the catheter allowed determination of the bladder and mass location.

A unilateral ureteral obstruction doesn’t often result in a relevant AKI.⁶ Since bilateral hydronephrosis would be expected if there was bladder obstruction, one of the possible explanations for such injury is the activation of the reninangiotensin system causing vascular constriction and ureteral spasm in the contralateral kidney, leading to renal hypoperfusion.⁶ Moreover, the basal kidney function in this diabetic, hypertensive patient was not known, leading to a possible overestimation of the AKI.

POCUS use during physical examination is a dynamic process that increases diagnostic accuracy and speed,^2,3and helps monitoring the results and complications of performed procedures.^1,4,5