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,
Rudy DC, Woodside JR. Perinephric Abscess Radiologically Mimicking Dilated Bowel. JAMA. 1983;249(3):401–402. doi:10.1001/jama.1983.03330270065040
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: