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  • Had subcutaneous ureteral bypass (SUB) devices placed two years prior for bilateral ureteral calculi obstruction.
  • Presented for ADR, anorexia.
  • Ultrasound was performed to further evaluate clinical signs and to check the SUB.
  • Linear shadow extending through the caudal pole of the left kidney likely represents the SUB; the tip of the SUB extends normally to a mildly dilated left renal pelvis.
  • The kidney is surrounded a large amount of echogenic fluid, compressing/flattening kidney margins.
  • ┬áHyperechoic retroperitoneal fat surrounds the kidney and fluid.
  • Mild proximal left ureter dilation with shadowing calculus.
  • Multifocal shadowing calculi in the mildly dilated left renal pelvis.
  • Large volume echogenic subcapsular fluid: may represent infection (pus/abscess), hemorrhage, or malignancy (LSA).
    • With severe compressive nephropathy.
  • Left renal and ureteral calculi with mild pelvic dilation; may represent pyelonephritis and/or chronic obstruction.

The SUBs were flushed but they had pus in them. The fluid around both kidneys was cultured and came back as resistant enterococcus. The patient was treated with Linezolid and Marbofloxacin. The patient continued to do well following repeated US-guided drainage and antibiotic therapy.