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A 44-year-old female presented to the ED with several day history of left flank pain, fever and malaise. The patient relates a history of recurring UTIs but is on no antibiotic prophylaxis and denies history of recent hospitalization. Her vitals signs are stable and she is noted to have a temperature of 100.8 F. Her physical examination is only significant for left CVA tenderness. Urinalysis reveals: >100 WBCs, 30-100 RBCs, large bacteria and a pH of 8.5. Her creatinine was 1.3 and her WBC was 18.4. You perform a focused left renal ultrasound and note the following......
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