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Within the left renal pelvis there is a hyperechoic, strongly shadowing structure with adjacent mild renal pelvic and diverticular dilation. There is a focal hyperechoic effusion with abnormal echoes noted in the caudal pole of the left kidney that is subcapsular in position. There is a surrounding increased hyperechogenicity of the retroperitoneal fat (some degree of hyperattenuation) along with a mild perinephric effusion. Within the urinary bladder there is a suspended echogenic fluid with some evidence of reverberation from some of structures. There is thickening of the cranioventral apical portion of the urinary bladder wall with multiple mucosal pedunculated thickened areas that’s extended into the UB lumen. There are multiple gravity dependent hyperechoic structures with distal acoustic shadowing. There is a mild anechoic peritoneal effusion adjacent to the urinary bladder. Based on the images provided a dilated proximal left ureter is not seen.

Mineralized left nephrolithiasis with mild hydronephrosis, subcapsular echogenic fluid collection, retroperitoneal inflammation and fluid. Polyploidy chronic cystitis with multiple mineralized cystic calculi.​
The left renal changes are consistent with an acute event where there is retroperitoneal inflammation and possible abscess formation along the caudal pole of the left kidney that is subcapsular. The possibility of an obstructive nephropathy is considered and retroperitoneum is possible. ​
The UB changes are consistent with the chronic polyp weighed cystitis with multiple mineralized calculi and cellular debris or crystalline structures in the fluid within the UB.​
Because of the possible obstructive nephropathy and caudal pole abscess, centesis of these areas should be done. Further evaluation of the right kidney is necessary in case a nephrectomy of the left would be considered. An EU or CT EU could be done to better define the possibility of proximal ureteral or renal pelvic rupture/leakage.​
UB – centesis for UA with culture and sensitivity. Future surgery (cystotomy) for removal of stones as indicated.​

The caudal pole was a renal abscess with E.coli being cultured (also from the urine). An EU documented evidence of renal pelvic/proximal ureteral leakage. The dog was not azotemic and the right kidney had normal EU appearance and features of contrast medium excretion. A left-sided nephrectomy and cystotomy (stone removal) was done.