Age: 66
Sex: Female
Indication: Generalized abdominal pain
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Case #67
Findings
- Lower chest
- Mild dependent atelectasis
- Small right pleural effusion
- Moderate-sized hiatal hernia
- Partially imaged central venous catheter with tip in the right atrium
- Abdomen/Pelvis
- Marked diffuse colonic distension measuring up to 9 cm in diameter with transition to normal caliber in the distal sigmoid colon where there is marked circumferential mural thickening
- Mural thickening of the transverse and descending colon
- Fistulous tract along the posterior margin of the distal sigmoid colon extending inferiorly toward the vaginal apex
- Moderate volume ascites without loculated collection or free air
- Diffuse mesenteric edema
- Locules of gas along the right anterior aspect of the urinary bladder with circumferential bladder wall thickening
- Hysterectomy
- MSK
- Multiple lower thoracic and lumbar vertebral body compression fractures status post vertebral augmentation from T12-L4
- Polyarticular degenerative changes
- Osteopenia
Diagnosis
- Large bowel obstruction (colonic stricture)
Sample Report
Findings concerning for large bowel obstruction with transition point in the sigmoid colon where there is circumferential mural thickening. Primary differential considerations are neoplasm and postinfectious/postinflammatory stricture. Recommend surgical evaluation.
Bowel wall thickening of the transverse and descending colon is concerning for superimposed colitis, which may relate to infectious, inflammatory, or ischemic etiologies.
Possible colovaginal fistula. This could be further evaluated with a CT pelvis with rectal contrast.
Small amount of gas along the anterior right aspect of the urinary bladder which may relate to emphysematous cystitis, colovesical fistula, or could be secondary to recent instrumentation.
Moderate volume ascites without loculated collection.
Multiple thoracic and lumbar compression fractures status post multilevel vertebral augmentation. Consider MRI for further evaluation if there is clinical concern for acute fracture.
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