Age: 82
Sex: Female
Indication: Generalized abdominal pain
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Case #41
Findings
- Lower chest
- Mild dependent atelectasis/scarring
- Scattered subcentimeter calcified granulomas
- Trace left pleural effusion
- Coronary artery calcification
- Moderate-sized hiatal hernia with circumferential thickening of the lower thoracic esophagus
- Abdomen/Pelvis
- Free fluid and gas about the descending colon in an area of focal dilation and possible pneumatosis
- Gas tracks in the left anterior pararenal space and left paracolic gutter
- No bowel obstruction
- Nodular hepatic surface contour with multiple subcentimeter hypodensities, which are too small to characterize
- Cholelithiasis
- 10 mm hypodense structure in the pancreatic head and 7 mm hypodense structure in the pancreatic tail
- Small splenic artery aneurysm measuring ~1 cm
- Atherosclerotic calcification of the abdominal aorta and branch vessels without aortic aneurysm
- Hysterectomy
- MSK
- Right total hip arthroplasty with heterotopic ossification adjacent to the proximal right femur
- Remote right inferior pubic ramus fracture
- Grade 2 anterolisthesis of L3 on L4 and of L4 on L5
- Scoliotic curvature with rightward translation of L4 on L5
- Compression fractures involving T9-L5 without substantial bony retropulsion
- Left L3 pars defect
- Osteopenia
Diagnosis
- Colonic perforation
Sample Report
Colonic perforation in the descending colon with small volume pneumoperitoneum. Given formed stool in this region, stercoral perforation is a consideration. Other considerations include ischemia or perforated neoplasm. Recommend surgical evaluation.
Multilevel thoracolumbar compression fractures, which are age-indeterminate in the absence of prior imaging for comparison. Recommend correlation with point tenderness and consideration of MRI for further evaluation if there is concern for acute fracture.
Hypodense structure in the pancreas measuring up to 10 mm. If no prior imaging is available to document stability, recommend followup pancreatic protocol CT or MRI in 2 years.
Moderate-sized hiatal hernia with mural thickening of the lower thoracic esophagus which may relate to reflux esophagitis.
Nodular hepatic surface contour. Recommend correlation with clinical and laboratory evidence of cirrhosis.
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