Clinical presentation
A 52 year old man with a known history of renal stones presented with symptoms and signs of right renal colic. No fever or infectious signs were noted. Right ureteral stone impaction was diagnosed and treated by ureteroscopy and internal ureteral stenting. Twenty four hours later he complained of fever that occurred concomitantly with a vague crampy abdominal pain. An abdominal ultrasound was normal. Blood and urinary cultures were taken and a broad spectrum antibiotherapy was started for a presumed pyelonephritis. Fever subsided within 48 hours, cultures were negative, and the patient was discharged five days later.
The day after discharge he was readmitted to hospital for septicaemia. Physical examination showed high temperature with normal blood pressure and right upper abdominal tenderness.
Question
An abdominal computed tomography scan was performed (figs 1, 2). What does it show?
Figure 1
Figure 2
See page 424 for answer
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