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Introduction: Emphysematous pyelonephritis is a rare, acute, and life-threatening necrotizing renal infection caused by gas-producing facultative anaerobes, such as Escherichia coli, Klebsiella, and Proteus, most commonly in the setting of underlying diabetes mellitus. Pneumomediastinum is a rare imaging finding in this disease, and a high index of suspicion is required for diagnosing emphysematous pyelonephritis in patients presenting with pneumomediastinum, in the right clinical setting. Case presentation: We present the case of a middle-aged female patient with symptoms and laboratory findings indicating infection, renal failure, and hyperglycemia, and a personal history of diabetes mellitus. The imaging procedures revealed findings of a severe and advanced necrotizing renal infection with parenchymal destruction and intraparenchymal gas collections extending into the perirenal and pararenal spaces. We established the diagnosis of emphysematous pyelonephritis accompanied by perirenal abscess formation and pneumoretroperitoneum, with gas collections propagating into the mediastinum. In the setting of such a severe form of infection, the patient underwent immediate surgery with left nephrectomy. Despite prompt and intensive treatment, the patient unfortunately succumbed to the disease during the postoperative period. Conclusion: Pneumomediastinum is a rare complication of retroperitoneal processes, and, when present, indicates their extensiveness, often being an ominous prognostic sign. By presenting this case, we aim to highlight the severity of this form of renal infection and the unequivocal need for immediate response, as well as to emphasize the significance of imaging findings, which are somewhat unusual, but should raise suspicion of an insidious and serious retroperitoneal infection.

Clearly defined protocols and multidisciplinary approach present a milestone for patients' condition evaluation. Ultrasound is a fast, accessible, non-invasive and repeatable radiological examination and has an important place in the trauma algorithms. It detects trauma of parenchymal and hollow abdominal organs, hematoperitoneum, and helps in the assessment of volume status. Ultrasound in trauma is performed according to the Focused Assessment with Sonography for the Trauma (FAST) protocol or as a standard ultrasonographic examination of the abdomen and can be repeated to monitor morphological changes due to indications for emergency surgical treatment.

Ultrasound is an essential and often initial visualization diagnostic procedure in all algorithms for urgent care of acute abdominal conditions. Ultrasound is a fast, accessible, non-invasive diagnostic examination method that does not involve ionizing radiation and can be repeated. It is vital in detecting free fluid in the abdominal cavity, acute pathological conditions of parenchymal and hollow organs, and assessing volemic status. Ultrasound efficiently and accurately diagnoses acute pathological conditions of the hepatobiliary and urogenital system. It certainly makes a significant contribution to the definitive diagnosis of pathological conditions of the gastrointestinal and vascular systems and can help detect pneumoperitoneum as an indication for urgent surgical treatment.

COVID - 19 is a 21st-century pandemic. Coronavirus 2 (SARS-CoV-2) causes coronavirus disease - COVID-19 (Corona Virus Disease-19), zoonose. The virus was previously known as the 2019 novel coronavirus. A non-specific and most common clinical and radiological finding is pneumonia, which was called novel coronavirus-infected pneumonia (NCIP) duo to its previous virus name. Pneumonia is bilateral, peripheral localization, and basal distribution. So far, there is no specific treatment or vaccine to prevent COVID-19; all measures consist of supportive therapy. The clinical presentation varies in severity from asymptomatic to mild form of the disease, over severe forms to fatal outcomes. Depending on the stage of COVID-19, the findings obtained using radiological methods also depend. About half of the patients have a normal CT scan within the first two days of the onset of the disease. However, the occurrence of pathological findings reaches its maximum between days 9 and 13. At first, the zones of "ground glass" opacification are present, followed by the discovery of "crazy paving" , and then the development of consolidation. With the improvement of the disease, fibrosis zones occur, and the changes recede one month and beyond. Echosonography has an important place in the monitoring and management of severe patients in intensive care units, and especially in lung conditions.

Accessory liver lobes (ALL) are defined as supranumerary liver lobes, composed of normal liver parenchyma in continuity with the liver, in contrast to ectopic liver lobes (ELL) that have no anatomical continuity with the normal liver. Case report: In this article we report on a rare radiological diagnosis of an synchronous accessory and ectopic liver lobe using ultrasonography (US) and computed tomography (CT). A 59-year-old female with no symptoms was admitted to our hospital due to preventive exam. Abdominal ultrasonography revealed a high echoic 6 cm x 5 cm soft tissue area in right anterior subhepatic space with distinct margins, a uniform echo and blood flow and was suspected to be abdominal tumor. An enhanced abdominal computed tomography (CT) showed the irregular 65 mm x 48 mm x 32 mm mass in the right hypochondrium below IV and V liver segment with clear margins, a uniform density, texture and contrast enhancement as normal liver tissue. In same patient CT also showed small 16 mm x 12 mm mass in posterior mediastinum in right retrocrural space so diagnosis of accessory and ectopic liver lobe was confirmed. An accessory liver lobe is adjacent and attached to the liver by its own mesentery, while an ectopic liver lobe is one that is completely detached from the normal liver parenchyma. Conclusion: Ultrasound can show mass in the abdomen, which is most commonly in the subhepatic area, but very rarely can initially diagnose ALL or ELL due to different echogenicity of the liver parenchyma in different acoustic windows. In the case of an atypical CT presentation, an MR examination of the abdomen is indicated but it is very rarely. Fast and accurate radiological diagnosis of ALL and ELL is important in the prevention of unnecessary invasive diagnostic procedures such as laparotomy and thoracotomy which are needed only in cases of complications.