A Case of Delayed Diagnosis of Acute Pyelonephritis in a Horseshoe Kidney in an Elderly Patient

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It is difficult for clinicians to predict the existence of undiagnosed asymptomatic congenital malformation, particularly in the emergency department (ED) setting. While it is sometimes directly associated with disease prevalence and clinical manifestation, we could overlook this significant background information without awareness. When an elderly patient with undiscovered malformation came to ED, the situation might become more challenging because their presentations are often ambiguous or atypical compared to younger patients. This leads to diagnostic delay due to some cognitive biases. In such situations, analytical thinking, especially consideration from the anatomical or physiological perspectives, should be warranted as well as intuitive thinking based on reconsidering the patient's sensitivity of specific diseases. Herein, we report a good example: delayed diagnosis of acute pyelonephritis in a horseshoe kidney in an 83-year-old woman.