Sepsis of unknown origin being treated in ICU. Source of sepsis?
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The left kidney is somewhat swollen, enhances less than the right, and demonstrates extensive surrounding stranding. Although the collecting system is a little prominent, with enhancing mucosa, no ureterolithiasis can be identified (a few pelvic phleboliths can be seen to be separate from the ureter on the MPR of the thin slices - not shown). No abscess is identified, although both kidneys demonstrate cortical scars, presumably related to prior (pediatric) reflux.
Pyelonephritis usually presents with loin pain, however in the elderly, localizing signs are often absent. It is crucial to ensure the collecting system is not obstructed as an infected obstructed kidney needs urgent drainage.