Wk 3, Case 26 - Review

Report

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

COMPARISON: None.

FINDINGS:

LOWER THORAX: There are bibasilar linear opacities related to subsegmental atelectasis. There are vascular calcifications of the aortic valve and coronary arteries. There is a small hiatus hernia.

HEPATOBILIARY: No focal hepatic lesions. No biliary ductal dilatation.


SPLEEN: No splenomegaly.

PANCREAS: No focal masses or ductal dilatation.

ADRENALS: No adrenal nodules.

KIDNEYS/URETERS: There are multiple hypodense lesions in the bilateral kidneys, with the largest measuring 12 mm in the right upper pole, consistent with renal cysts. There are multiple non obstructing calculi in the left kidney with the largest measuring 5 mm. There is no evidence of hydronephrosis or hydroureter.

PELVIC ORGANS/BLADDER: Part of the pelvic organs are obscured by metallic artifact from a prosthetic left hip. The visualized bladder is unremarkable. The prostate gland appears enlarged.

PERITONEUM / RETROPERITONEUM: There is a small amount of free air in the anti-dependent areas of the peritoneum. There is a small amount of perihepatic ascites. There is a small amount of perihepatic ascites. There is a small amount of pelvic free fluid. There is a small amount of free fluid in the right lower quadrant.

LYMPH NODES: No lymphadenopathy.

VESSELS: There are atherosclerotic calcifications in the aorta and its tributaries.

GI TRACT: There are diverticula in the sigmoid colon with associated bowel wall thickening and adjacent soft tissue stranding at the junction of the descending and sigmoid colon, consistent with acute diverticulitis. There is a small fluid attenuation collection with wall enhancement measuring up to 1.7 x 1.1 cm which may represent an adjacent abscess. There is secondary small bowel thickening adjacent to the pericolonic inflammation.
There is significant stool accumulation within the cecum.

BONES AND SOFT TISSUES: There has been a left hip replacement. There are degenerative changes in the lumbar spine. There is complete obliteration of the L4 – L5 vertebral disc and fusion of the vertebral bodies. There are no suspicious lytic or blastic lesions seen.

IMPRESSION:

Findings consistent with acute diverticulitis at the junction of the descending colon and sigmoid colon.
Small amount of free air in the non-dependent areas of the peritoneum suggesting perforation.
1.7 x 1.1 cm fluid attenuation collection adjacent to the area of diverticulitis concerning for adjacent abscess formation.