A bizarre abdominal XR in a patient with fever and dysuria

Abstract

A 50 year old Chinese male with no known
past medical history presented with dysuria
and fever for 3 days. On presentation at the
emergency department, he was febrile with
temperature of 39°C, tachycardic with heart
rate of 110 beats per minute, and blood
pressure of 90mmHg systolic 50mmHg
diastolic. On examination, there was fullness
in the right upper quadrant of his abdomen
with associated tenderness on palpation.
Renal punch was positive on the right.
White cell count and C-reactive protein
were elevated at 25.09 x 109/L and 221.9mg/L
respectively. Liver function test and renal
panel were unremarkable and within normal
range. Urine microscopic examination
showed pyuria of 120 white cells/uL. Blood
culture and midstream urine culture was
negative. An abdominal X-ray was performed
(Figure 1), showing a 13.1 x 11.3cm locule of
gas in right mid abdomen.