Case #31

Case #29

• Chest
  • Endotracheal tube terminates above the carina
  • Dependent bilateral lower lobe groundglass opacities
  • Scattered pulmonary nodules measuring up to 6 mm in the right upper lobe and 5 mm in the right middle lobe
  • Four chamber cardiomegaly
  • Post CABG changes
  • Heavy coronary artery calcification
  • Aortic valve and mitral annular calcification
  • Thoracic aortic atherosclerosis without aneurysm
• Abdomen/Pelvis
  • Abdominal aortic aneurysm measuring 5.3 x 3.8 cm in maximal transaxial dimensions with a craniocaudal span from the origin of the left renal artery to the aortic bifurcation
  • Loss of the normal fat planes between the aneurysm and the third segment of the duodenum with a small fistula extending from the aorta to the junction of the third and fourth duodenal segments and contrast density material layering in the distal duodenum
  • Periaortic soft tissue stranding with a likely additional site of contrast extravasation noted posteriorly in the more inferior infrarenal abdominal aorta
  • Surgical changes of aortobifemoral bypass with likely chronic occlusion of the native distal abdominal aorta and iliac vessels
  • Both common femoral arteries opacify via retrograde flow, with retrograde opacification also extending into the external and internal iliac arteries on the left
  • Narrowing at the origin of the celiac artery with poststenotic dilation
  • Gastric suction tube tip in the duodenal bulb
  • Bilateral renal atrophy and multifocal cortical scarring
  • Mild nonspecific mesenteric and perinephric fat stranding
  • Urinary bladder is decompressed around a Foley catheter
• MSK
  • No acute findings
  • Polyarticular degenerative changes
  • Midline laparotomy scar

• Aortoenteric fistula