Age: 76
Sex: Female
Indication: Right upper quadrant pain
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Case #3
Findings
- Lower chest
- Mild dependent atelectasis
- Coronary artery calcification
- Abdomen/Pelvis
- Dilated common bile duct and central intrahepatic bile ducts with extensive mural thickening and surrounding fat stranding
- No radiopaque gallstones
- Gallbladder wall thickening
- Diffusely decreased, heterogenous hepatic attenuation
- Decreased attenuation of the pancreatic head and uncinate process
- Several mildly enlarged lymph nodes in the hepatoduodenal ligament, likely reactive
- Colonic diverticulosis without adjacent inflammatory changes
- Bilateral tiny renal hypodensities, which are too small to characterize
- Trace fluid in the right paracolic gutter
- Heavy atherosclerotic calcification of the abdominal aorta and branch vessels without aneurysm
- Central low density within the main portal vein
- MSK
- No acute findings
- Osteopenia
- Partially imaged median sternotomy changes
Diagnosis
- Ascending cholangitis
Sample Report
Mild common bile duct dilation with extensive mural thickening of the extrahepatic and central intrahepatic bile ducts and surrounding periportal edema concerning for ascending cholangitis. No radiopaque biliary stones.
Mural thickening of the gallbladder and edematous appearance of the pancreatic head and uncinate process are likely reactive to the adjacent inflammation.
Diffuse low attenuation of the liver, which may relate to hepatitis. No evidence of abscess.
Central low density within the main portal vein is favored to relate to mixing of contrast opacified blood from the splenic vein and unopacified blood from the SMV. A repeat CT with more delayed contrast bolus timing could provide further evaluation for portal venous thrombosis if there is clinical concern.
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