A 72-year-old woman presented to the emergency department with shortness of breath, diffuse swelling and a haemoglobin of 4.2 g/dl. Her history was notable for an unusual necrotic occipital neck mass that had begun to enlarge and intermittently bleed over the past year. The patient was initially unable to tolerate a CT scan because of the neck mass, and care was further complicated by extended boarding for more than 24 h in the emergency department. Initial fevers were attributed to blood transfusion, but she subsequently developed septic shock and disseminated intravascular coagulation from Escherichiacoli bacteraemia, which led to anuric renal failure requiring haemodialysis. When the CT was performed, it revealed an obstructing ureteric stone which was the source of her infection, not the neck mass as had been assumed. This case underscores the importance of maintaining a broad and impartial differential diagnosis.
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机译：一名72岁的妇女因呼吸急促，弥漫性肿胀和4.2 g / dl的血红蛋白出现在急诊室。在过去的一年中，她的病史因异常的坏死枕颈肿块而开始扩大并间歇性流血。最初由于颈部肿块，患者无法忍受CT扫描，急诊室延长登机时间超过24小时使护理更加复杂。最初的发烧归因于输血，但随后她因感染埃希氏菌菌血症而引起败血性休克并弥散了血管内凝血，导致无尿肾衰竭需要进行血液透析。当进行CT扫描时，它发现输尿管结石是她的感染源，而不是假定的颈部肿块。该病例强调了保持广泛而公正的鉴别诊断的重要性。
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