Findings:
There is a new, likely reactive, small right pleural effusion and gallbladder wall thickening. There are evolutionary changes of the previously demonstrated segmental hypoenhancing regions in the right kidney with a developing renal abscess. The abscesses are more liquefied compared to prior exam. The contralateral heterogeneous enhancement of the upper pole of the left kidney is improving. The heterogeneous enhancement of the right kidney is persistent and compatible with ongoing pyelonephritis. The bladder is decompressed with a Foley catheter.

Impression:
There are evolutionary changes of the bilateral pyelonephritis with overall similar size of the developing right renal multiloculated abscess, which demonstrate a more liquefied appearance. Considering the multiloculated nature, the abscess is not amenable to percutaneous drainage. Consider continued therapy and repeating an exam in 48-72 hours.

Recommendations:
For your training purposes, recommendations are not included in this report.