Wk 5, Case 46 - Review

Report
CT of the abdomen and pelvis WITH intravenous contrast.
Scans were continued into the pelvis to evaluate for ischemia.

COMPARISON: None available.

FINDINGS:

LOWER THORAX: Filling defects in the subsegmental pulmonary arteries consistent with pulmonary emboli of indeterminate age.

HEPATOBILIARY: No focal hepatic lesions. No biliary ductal dilatation. Cholelithiasis without cholecystitis.

SPLEEN: No splenomegaly.

PANCREAS: No focal masses or ductal dilatation.

ADRENALS: No adrenal nodules.

KIDNEYS/URETERS: There is a large right extrarenal pelvis. There is stable right hydronephrosis.

PELVIC ORGANS/BLADDER: Calcifications in a fibroid uterus.

PERITONEUM / RETROPERITONEUM: No free air or fluid.

LYMPH NODES: No lymphadenopathy.

VESSELS: There is stenosis at the celiac origin. The proximal SMA is completely occluded with threadlike reconstitution distally on delayed phase. The IMA is occluded. The native bilateral common iliac arteries are completely occluded. There is a patent aortobifemoral bypass graft present. Extensive atherosclerotic changes in the aorta.

GI TRACT: There is bowel wall thickening of the ileum, which is non-specific but in the setting of SMA/IMA occlusion is strongly suggestive of mesenteric ischemic bowel disease. There is cecal wall enhancement which may also be related to ischemic changes. The sigmoid colon is decompressed and also possibly thickened. The patient is status post low abdominal resection with end to side reanastomosis. There is a hiatal hernia.

BONES AND SOFT TISSUES: No acute or aggressive osseous abnormality.

IMPRESSION:
Bowel wall thickening of the ileum with occlusion of the SMA/IMA concerning for mesenteric ischemia.