The urinary bladder presented a catheter with sand accumulation. The catheter placement appeared to be in normal position. Shadowing sand was noted in the bladder with a minor amount of free fluid around the bladder with reactive surrounding fat, which is suggestive of an aggressive process. The bladder wall was significantly edematous and this continued into the cystourethral junction. The bladder wall measured 0.74 cm at mild repletion. A minor amount of air accumulation was noted, which is normal as there was a catheter. The left kidney in this patient presented hyperechoic fat. This is consistent with fatty inflammation. Given the renal presentation, extension of inflammatory process with transcapsular inflammation is likely. The left kidney presented hypoechoic parenchyma with swollen contour and measured 4.23 cm with pyelectasia. Underlying pyelonephritis is likely in this case or minor pelvic dilation owing to history of obstruction. However, given the pericapsular inflammatory pattern pyelonephritis is likely. Inflamed pelvic fat also appeared present. The right kidney measured 4.72 cm with minor, pericapsular, increased fat echogenicity and pyelectasia.