Age: 84
Sex: Female
Indication: Vomiting, melena
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Case #18
Findings
- Lower chest
- Mild dependent atelectasis
- Mild four chamber enlargement of the heart
- Coronary artery calcification
- Moderate-sized hiatal hernia with layering fluid
- Abdomen/Pelvis
- Thrombus in the mid and distal SMA extending into proximal jejunal branches
- Mild luminal distension and wall hypoenhancement of an approximately 20 cm segment of jejunum in the left mid abdomen
- Liver is mildly enlarged with diffuse low attenuation of the hepatic parenchyma
- Scattered hepatic cysts and additional subcentimeter hypodensities which are too small to characterize
- Subcentimeter hypodensities in both kidneys are too small to characterize
- Appendectomy
- Colonic diverticulosis
- 5 mm enhancing lesion along the posterior aspect of the anus
- Uterine fibroid
- Trace free fluid layering in the anatomic pelvis
- MSK
- No acute findings
- Degenerative changes of the spine and pubic symphysis
Diagnosis
- Acute mesenteric ischemia due to arterial occlusion
Sample Report
Thrombus in the mid and distal SMA extending into proximal jejunal branches which may represent in situ thrombus versus thromboembolism. Mild distension and wall hypoenhancement of an approximately 20 cm segment of jejunum in the left mid abdomen is concerning for developing bowel ischemia. No pneumatosis, portal venous gas, or pneumoperitoneum.
Moderate-sized hiatal hernia with layering fluid, which places the patient at risk for aspiration.
Hepatomegaly with hepatic steatosis.
Small enhancing focus along the posterior aspect of the anus, which could represent an external hemorrhoid. Recommend correlation with physical exam.
Discussion
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