Author
Daniel A. Sweeney, MD
Attending Physician
Washington Hospital
Fremont, CA 94538
Case
History of present illness: A 55 year old woman presents from a skilled nursing facility with nausea and vomiting.
Past Medical History: CVA and aspiration pneumonia
Vital signs: BP 85/40 mmHg; pulse 135/min; Respiratory rate 20/min; pulse oximetry 94% on 2L NC; temperature 101.3°F
Physical Examination: opens eyes to touch, nonverbal, does not follow commands; decreased breath sounds over lower chest bilaterally on anterior exam
EKG: sinus tachycardia
Initial labs: WBC- 42 x 103/µL; Creatinine- 1.6 mg/dl; lactate concentration 5.2 mmol/L. urinalysis: specific gravity 1.025; nitrite negative; leukocyte esterase positive; RBCs 20-30/hpf; WBCs 15-25/hpf
Imaging: A CT head revealed no acute disease. CXR was reported as “bibasilar atelectasis versus infiltrates, clinical correlation recommended.”
Point-of-care abdominal sonography is performed and the following representative image is obtained by examining the left flank.
Question
What is the most likely source of sepsis in this patient?
