Right kidney shows enlargement & altered echogenicity with effacement of sinus fat. There are ill defined hyperechoic areas with poor acoustic shadowing, raising strong suspicion of air in pelvicalyceal system i.e. emphysematous pyelonephritis.
A hyperechoic, 11x12mm, rounded lesion seen at right upper renal pole, is ikely an angiomyolipoma.
Left kidney and urinary bladder are unremarkable.
Urgent CT KUB was suggested for further evaluation.