Roody Menager; Rebecca St Louis; Anst Gelin; Flawendjee Djaweelentz Jacques – This case discusses a 36-year-old man presented to the ED with dyspnea, fever, abdominal pain, and abdominal distention in the area where an intra-abdominal tumor was reported. After ultrasound-guided aspiration, pyonephrosis was diagnosed. In the absence of other capable specialists, the emergency physician performed a percutaneous nephrostomy procedure, and eight liters of pus were removed.