Demographics:
77 years old, Male
Indication:
Epigastric pain
Findings
Lower chest
- Mild centrilobular emphysema
- 4 mm nodule in the lingula
- Left lower lobe calcified granulomas
- Moderate coronary artery calcification
Abdomen/Pelvis
- Dilation of multiple loops of proximal and mid small bowel with transition point in the mid abdomen adjacent to a partially calcified 3 x 2 cm soft tissue mass in the small bowel mesentery with surrounding desmoplastic reaction
- Diffuse stranding in the small bowel mesentery with interloop fluid and multiple enlarged lymph nodes
- Multiple enlarged retroperitoneal lymph nodes with an index left para-aortic node measuring 2.4 cm in short axis
- Small volume abdominopelvic ascites
- Hepatomegaly with nodular surface contour of the anterior right hepatic lobe
- Multiple hypoattenuating hepatic lesions with ill-defined margins
- Small amount of layering high attenuation material in the gallbladder which could represent sludge or small stones
- Calcified granulomas in the spleen
- Mild diffuse pancreatic atrophy
- Punctate nonobstructing calculus in the upper pole of the right kidney
- Subcentimeter hypoattenuating lesions in the left kidney, which are too small to characterize
- Small volume free intraperitoneal fluid layering in the pelvis
- Atherosclerotic calcification of the abdominal aorta and branch vessels without aneurysm
MSK
- No acute osseous findings
- Mild degenerative changes of the spine
- Mild body wall edema
Diagnosis
Small bowel obstruction due to intestinal carcinoid tumor
Sample Report
Findings concerning for high-grade small bowel obstruction with transition point in the mid abdomen adjacent to a mesenteric mass. The imaging characteristics of this mass favor carcinoid tumor.
Likely metastatic lymphadenopathy in the small bowel mesentery and retroperitoneum and metastatic liver lesions. Consider DOTATATE-PET for further evaluation.
Nonspecific 4 mm pulmonary nodule in the lingula. Recommend attention on follow-up imaging.
Mildly nodular surface contour along the anterior right hepatic lobe. Recommend correlation with laboratory evidence of cirrhosis.
Discussion
References