Case of the Month

Our Imaging Case of the Month is presented as a part of the Imaging Department's residency teaching program. Each month a resident collaborates with one of our attending imaging physicians to present an interesting case to the Cedars-Sinai medical community. The case is used to teach both imaging and other residents at Cedars-Sinai. Below is the current Case of the Month.

Thomas J. Learch, MD

Submitted by Peyman Kangavari, MD, and Thomas J. Learch, MD.

A 41-year-old female with past medical history of renal stones and multiple prior urinary tract infections presents to the emergency department complaining of increased urinary frequency, intermittent fever, right flank pain and right upper quadrant abdominal pain. Symptoms have been intermittent for the past two months but has worsened in the past two days. Pain is described as intermittent, severe, "heavy" and "pressure-like" sensation. Pain and fever improve with over-the-counter NSAIDS. No other alleviating or exacerbating factors. In the past two months, the patient has been treated twice with oral antibiotics for urinary tract infections.

Review of systems was positive for fever, abdominal pain, nausea, polyuria, urinary frequency, and flank pain.

Physical examination in the emergency department was significant for tachycardia, tenderness to palpation in the right upper quadrant.

Initial laboratory findings were significant for severe leukocytosis with left shift, microscopic hematuria, pyuria and elevated urine leukocyte esterase.

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