A 62 year old female with uncontrolled diabetes mellitus presented with a history of acute onset right sided flank pain, fever with chills and rigors for a duration of 1 day. On examination, she had significant right sided renal angle tenderness with gaseous distention of the abdomen. On investigation, she was found to have neutrophil leukocytosis (WBC: 22 ×103/mm3 Neutrophils – 88%), and urinalysis revealed field full pus cells per high power field on microscopy. Ultrasonography revealed highly echogenic areas within the right kidney with a perinephric fluid collection in the right paracolic gutter. An X-ray KUB was performed and is shown below.