Age: 68
Sex: Female
Indication: Concern for bowel obstruction
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Case #88
Findings
- Lower chest
- No acute findings
- Aortic root and coronary artery calcification
- Abdomen/Pelvis
- Multiple fluid-filled, dilated loops of proximal and mid small bowel measuring up to 4 cm in diameter with gradual tapering to normal caliber in the distal small bowel
- Bowel wall thickening and submucosal edema involving a long segment of jejunum without convincing pneumatosis
- Oral contrast material only progresses into the proximal jejunum
- Normal caliber and appearance of the colon
- Thrombosed superior mesenteric vein with thrombus extending to the portosplenic confluence but not into the main portal vein
- Multiple engorged mesenteric vessels and edema in the jejunal mesentery
- Small volume abdominopelvic ascites with scattered interloop fluid along the jejunal mesentery
- Intraperitoneal fluid extends into a small fat-containing umbilical hernia
- Nodular hepatic surface contour with mild left lobe and caudate hypertrophy
- Splenomegaly
- Cholelithiasis
- Multiple hypoattenuating structures in the right greater than left kidneys
- Multifocal left renal cortical atrophy
- Urinary bladder is decompressed around a Foley catheter. Intraluminal gas likely relates to instrumentation
- Hysterectomy
- Atherosclerotic calcification of the abdominal aorta and branch vessels without aneurysm
- MSK
- No acute findings
Diagnosis
- SMV thrombosis in the setting of cirrhosis
Sample Report
SMV thrombosis extending to the portosplenic confluence but not into the main portal vein. Associated mesenteric venous engorgement and edema. Wall thickening and submucosal edema involving a long segment of jejunum, which may relate to congestive edema and/or developing bowel ischemia. Although there is no convincing pneumatosis, recommend correlation with serum lactate values.
Dilation of multiple loops of proximal and mid small bowel likely represents an ileus secondary to mesenteric venous thrombosis.
Cirrhotic liver morphology with findings suggestive of portal hypertension including splenomegaly and small volume ascites.
Incompletely characterized bilateral hypoattenuating renal lesions, which can be further assessed with renal ultrasound.
Cholelithiasis without evidence of acute cholecystitis.
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