CT hypoperfusion complex from pyelonephritis

Numerous signs of shock/visceral hypoperfusion:

• bilateral hyperenhancing adrenal glands
• Hyperenhancinghyperenhancing, thickened small bowel mucosa
• Mottledmottled enhancement of the liver and spleen on portal venous phase, which becomes homogeneous on delayed phase
• Gallbladdergallbladder wall thickening

Surprisingly, the IVC is round rather than flattened due to ongoing fluid resuscitation. Periportal oedema and pericholecystic free fluid. Small volume of right retroperitoneal fluid.

Asymmetric enhancement of the kidneys, less on the right with multiple peripheral wedge-shaped regions of reduced/non-enhancement. Multiple tiny bilateral non-obstructive renal calculi. No ureteric calculi. No hydronephrosis. Incidental note of double right renal veins and retro-aortic left renal vein.