A 30-year-old woman with past medical history of type 2 diabetes presents to the emergency department with 3 days of vague abdominal/back pain, with associated subjective fever, chills, nausea and vomiting. She states she was recently seen and evaluated at an outside hospital, where she was diagnosed with a urinary tract infection and discharged home on oral antibiotics, which she has been taking for 3 days, but does not feel any better.

Renal abscesses are infections contained to an encapsulated region within the renal parenchyma and are often divided into cortical or corticomedullary by location.

Renal and perinephric abscesses are serious, often missed diagnoses in the emergency department that are important for emergency clinicians to keep on their differential, as only 35% of renal and perinephric abscesses are correctly diagnosed in the emergency department.

UA is not necessarily consistent with these infections unless the abscess involves the collecting system.

Mortality of renal and perinephric abscesses can be as high as 14%.

CT scan is the single best way to diagnosis these disease processes, but bedside ultrasound can offer a quicker diagnosis in some.

Broad-spectrum antibiotics are the mainstay of treatment for all confirmed diagnoses and the size of the abscess (>5cm) will determine need for drainage.

All patients with confirmed diagnosis should be admitted for continued antibiotics, culture results and urology consultation.

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