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January 21, 1983

Perinephric Abscess Radiologically Mimicking Dilated Bowel

Author Affiliations

From the Division of Urology, University of New Mexico School of Medicine, Albuquerque.

JAMA. 1983;249(3):401-402. doi:10.1001/jama.1983.03330270065040

History  A 45-year-old diabetic woman had the acute onset of fever, chills, nausea, vomiting, right flank pain, and dysuria. She was admitted to the referring hospital with diagnoses of poorly controlled diabetes mellitus and gram-negative shock. She was resuscitated with intravenous (IV) fluids, a continuous insulin infusion (insulin zinc suspension), and parenteral antibiotics. A right pleural effusion subsequently developed, and multiple thoracenteses were nondiagnostic. The right kidney could not be visualized in an IV pyelogram. She was transferred to the University of New Mexico Hospital because of persistent fever after two weeks of antibiotic therapy.A plain film of the abdomen demonstrated a localized collection of gas, with an air-fluid level in the upper right quadrant suggesting dilation of the hepatic flexure of the colon or a dilated loop of small bowel (Fig 1). No calcifications were detected. Shortly after admission, a right retrograde pyelogram showed a distorted collecting system,