Age: 64
Sex: Female
Indication: Left lower quadrant pain
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Case #89
Findings
- Lower chest
- Interlobular septal thickening and mild dependent groundglass opacities in the visualized lung bases
- Coronary artery and aortic valve calcifications
- Left atrial and left ventricular dilation
- Subendocardial hypoattenuation in the left ventricular apex, likely relating to prior infarct
- Small hiatal hernia with fluid layering in the distal esophagus
- Abdomen/Pelvis
- Multiple fluid-filled, dilated loops of proximal and mid small bowel measuring up to 3.5 cm in diameter with transition point in the right lower quadrant
- Distal small bowel and colon are nondilated
- Mild edema in the jejunal mesentery
- No convincing pneumatosis
- Substantial atherosclerotic calcification of the abdominal aorta and branch vessels
- Infrarenal abdominal aortic aneurysm measuring 4.2 x 4 cm in cross-sectional diameter with discontinuous peripheral calcification and a focal outpouching along the right posterior wall
- No retroperitoneal hematoma
- Likely short segment dissection of the right common iliac artery with associated aneurysmal dilation measuring up to 2.5 cm in diameter
- Moderate asymmetric atrophy of the right kidney
- Cholecystectomy
- Hysterectomy
- MSK
- No acute findings
- Small fat-containing supraumbilical hernia and tiny fat-containing umbilical hernia
Diagnosis
- Abdominal aortic aneurysm, impending rupture
- Small bowel obstruction
Sample Report
Findings suggestive of high-grade small bowel obstruction with transition point in the right lower quadrant, likely relating to intraabdominal adhesions. A vascular etiology is difficult to exclude on this noncontrast study.
Infrarenal abdominal aortic aneurysm measuring up to 4.2 cm with discontinuous peripheral calcification and a focal outpouching along the right posterior wall. These findings are associated with an increased risk for aneurysm rupture, though there is no evidence for uncontained rupture at this time. Recommend evaluation by vascular surgery.
Focal dissection of the right common iliac artery, which is likely chronic but not well assessed on this noncontrast study.
Atrophic right kidney, which may relate to extensive atherosclerotic disease.
Left atrial and left ventricular dilation with findings suggestive of a chronic left ventricular apical infarct.
Mild pulmonary edema in the visualized lung bases.
Small hiatal hernia with fluid layering in the distal esophagus, which may relate to gastroesophageal reflux.
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