A patient was admitted to hospital for worsening dysuria (lasting one week), the onset of fever and back pain on the left side. She was admitted to ICU for fever, hypotension and tachycardia. Administration of catecholamines was necessary. Haemocultures were positive for E. coli. Ultrasonography during admission did not reveal congestion in the urinary tract. The patient complained of pain when examining the region above the left kidney.
Patient´s medical history includes heart insufficiency (ejection fraction 28 %), significant mitral and tricuspid regurgitation, permanent atrial fibrillation and chronic renal failure (creatinine approximately 250 umol/l).
Check abdominal ultrasonography: