Demographics:
80 years old, Male
Indication:
Generalized abdominal pain
Findings
Lower chest
- Mild dependent atelectasis
- Mild scarring in the right middle lobe and lingula
- Aortic valve/root and coronary artery calcification
- Small hiatal hernia
Abdomen/Pelvis
- Marked distension of a redundant loop of sigmoid colon which is folded on itself with transition points proximal and distal to the distended segment and swirling of the feeding mesentery
- Adjacent fat stranding and ill-defined fluid in the sigmoid mesentery
- The duodenum and the majority of the small bowel reside in the right hemiabdomen
- Scattered colonic diverticula
- Cholecystectomy
- Mild intrahepatic and extrahepatic biliary duct dilation with the common bile duct measuring up to 9 mm in diameter
- Multiple hypoattenuating lesions in the spleen with the largest measuring 2 cm
- Diffuse pancreatic atrophy with numerous parenchymal calcifications and main duct ectasia
- Bilateral renal hypoattenuating lesions, which are too small to characterize
- Prostatomegaly
- Infrarenal abdominal aortic aneurysm measuring up to 5 cm with left eccentric mural thrombus
- Left common iliac artery aneurysm measuring up to 1.6 cm
MSK
- No acute findings
- Remote bilateral rib and left L2 transverse process fractures
- Polyarticular degenerative changes
Diagnosis
Sigmoid volvulus
Sample Report
Findings consistent with sigmoid volvulus. No evidence of perforation or loculated fluid collection. Recommend surgical consultation.
5 cm infrarenal abdominal aortic aneurysm and 1.6 cm left common iliac artery aneurysm. Recommend outpatient vascular surgery referral.
Mild intra- and extrahepatic biliary duct dilation which may be physiologic in the postcholecystectomy state. Recommend correlation with liver function tests if there is concern for acute biliary pathology.
Sequelae of chronic pancreatitis.
Findings suggestive of intestinal malrotation, though evaluation is limited by substantial intraabdominal mass effect from the dilated sigmoid colon and abdominal aortic aneurysm.
Discussion