Age: 24
Sex: Male
Indication: Generalized abdominal pain, shortness of breath
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Case #26
Findings
- Lower chest
- Large pericardial effusion
- Small bilateral pleural effusions
- Bilateral lower lobe dependent airspace consolidation
- Nodular opacities in the right middle and lower lobes with one right lower lobe nodule demonstrating cavitation
- Partially imaged central venous catheter tip at the inferior cavoatrial junction
- Abdomen/Pelvis
- Extensive nonocclusive venous thrombosis extending from the left common femoral vein into the left external iliac and common iliac veins and into the distal IVC, nonocclusive thrombus in the right external iliac vein, and nonocclusive thrombus in the IVC at the origin of the right renal vein
- Decreased caliber of the intraabdominal arteries
- Hyperenhancing adrenal glands
- Small bowel is decompressed with possible widespread mild mucosal hyperenhancement
- Hepatomegaly with heterogeneous hepatic parenchymal enhancement and periportal edema
- Gallbladder wall thickening and adjacent stranding without distension or radiopaque calculi
- Large low-density collection in the spleen measuring 15 x 9 x 12 cm with incomplete internal septations
- Fat stranding about the pancreatic head and uncinate process
- Low density area in the pancreatic tail measuring 2.5 cm
- Atrophic, hypoenhancing kidneys without hydronephrosis
- Multiple mildly enlarged mesenteric and retroperitoneal lymph nodes, likely reactive
- Mild circumferential bladder wall thickening
- Small volume abdominopelvic ascites
- Replaced right hepatic artery from the SMA
- MSK
- No acute findings
Diagnosis
- Hypoperfusion complex
Sample Report
Large pericardial effusion which places the patient at risk for cardiac tamponade. Recommend correlation with echocardiography.
Findings concerning for hypoperfusion complex. No bowel pneumatosis or portal venous gas.
Multifocal acute nonocclusive venous thrombosis involving the infrahepatic IVC, left common iliac vein, both external iliac veins, and left common femoral vein.
Findings at the lung bases raise concern for pneumonia/septic embolic disease.
Large collection in the spleen which may represent an intrasplenic pseudocyst related to prior pancreatitis, though superinfection/abscess is not excluded.
Fat stranding adjacent to the pancreatic head may represent acute pancreatitis. Hypodense area in the pancreatic tail may represent focal necrosis or variable enhancement in the setting of hypoperfusion.
Heterogeneous hepatic enhancement likely relates to differential perfusion in the low volume state.
Circumferential bladder wall thickening. Recommend correlation with urinalysis for signs of cystitis.
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