2 days of abdominal pain and vomiting. Hypotensive and diffusely tender abdomen. Metabolic acidosis.
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Patchy areas of hypo-enhancement of the right kidney are present, involving the full thickness of the cortex in many places. Right renal artery and vein enhance normally. No hydronephrosis or stones. Two right ureters join just proximal to the vesico-ureteric junction and are inflamed. Small volume of free right retroperitoneal fluid. No renal or perinephric abscess. Small right pleural effusion.
Swelling and patchy hypo-enhancement extending to involve the cortex, in the context of sepsis, indicate a right renal infection. The right ureter(s) are also involved. There is no stone seen as a causative factor and no complication such as a renal or perinephric abscess. Clinical recovery ensued upon appropriate antimicrobial administration.
Involvement of the cortex by hypo-enhancement helps to differentiate from an infarct in which the cortex is spared - the claw sign.