Wk 2, Case 18 - Review

TECHNIQUE:
CT of the abdomen and pelvis with intravenous contrast.

COMPARISON: None.

FINDINGS:
LOWER THORAX: Mild bibasilar atelectasis.

HEPATOBILIARY: No focal hepatic lesions. No biliary ductal dilatation. Subcentimeter hypodensities in the left hepatic lobe and in the caudate lobe likely represent cysts. Gallbladder unremarkable.
SPLEEN: No splenomegaly.
PANCREAS: No focal masses or ductal dilatation. ADRENALS: No adrenal nodules.
KIDNEYS/URETERS: No hydronephrosis, stones, or solid mass lesions.
PELVIC ORGANS/BLADDER: Prostate is enlarged. Bladder unremarkable.
PERITONEUM / RETROPERITONEUM: There is free air within the peritoneum, the largest collections seen anterior to the liver as well as within the right lower abdomen. There is a small amount of free fluid as well as diffuse fat stranding throughout the peritoneum.
LYMPH NODES: No lymphadenopathy.
VESSELS: Atherosclerotic calcification within the abdominal aorta and its branches.

GI TRACT: There is a defect within the superior aspect of the duodenal bulb with leakage of free air, seen for instance on coronal image 25, consistent with a perforated ulcer. There is marked wall thickening and surrounding inflammatory fat stranding involving the distal stomach. There is no bowel distention. There is mild apparent wall thickening within the distal colon, which may reflect underdistention or may be reactive. The appendix is normal.

BONES AND SOFT TISSUES: There are lytic lesions within the sacrum and the left iliac bone as well as other lesions scattered throughout the spine, consistent with known multiple myeloma. There are degenerative changes of the visualized spine.

IMPRESSION:
Perforation of the duodenal bulb, likely reflecting a perforated ulcer, with intraperitoneal free air, free fluid, and diffuse fat stranding.