A 91-year-old patient was admitted to the department of internal medicine for weakness and fever. The patient was slightly somnolent, unable to walk and haemodynamically stable. Physical examination did not reveal any pathological finding. Lab results showed increased levels of inflammatory markers. The patient was admitted to a standard ward for suspicion of urinary tract infection and received antibiotic therapy. Admission abdominal ultrasonography revealed gallbladder hydrops and shrinking kidney.
Check ultrasonography was performed on the 4th day of hospitalisation. Lab tests again revealed increased levels of inflammatory markers. Consequently, CT was performed. Based on the finding, the patient was indicated for surgical revision. After administration of premedication, the Coomb´s test was found to be positive. It was going to take a longer time to determine the antibodies and to crossmatch blood for surgery. However, the premedication already worked even so much, that the patient had to be intubated and admitted to the ICU.
Bed-side ultrasonography: