Demographics:
70 years old, Male
Indication:
Upper abdominal pain, nausea
Findings
Lower chest
- Mild dependent atelectasis
Abdomen/Pelvis
- Mural thickening of the gastric antrum and proximal duodenum with a superiorly-directed ulcer from the distal antrum and small volume pneumoperitoneum and hemorrhage in the right upper quadrant
- Small volume hemoperitoneum tracking along the right paracolic gutter and layering in the anatomic pelvis
- Multiple fluid-filled mildly dilated loops of proximal and mid small bowel
- Gallbladder is distended without wall thickening, radiopaque gallstones, or biliary duct dilation, which may be physiologic in the fasting state
- Mild diffuse pancreatic atrophy
- Distended urinary bladder with multiple small diverticula
- Prostatomegaly
MSK
- No acute findings
- Remote T12 compression fracture with multilevel posttraumatic fusion in the lower thoracic spine and retrolisthesis of L1 on L2 resulting in moderate to severe narrowing of the spinal canal
- Remote ununited fracture of the left hip with severe degenerative changes
- Marked atrophy of the lower abdominal and pelvic musculature
Diagnosis
Ruptured gastric ulcer
Sample Report
Findings concerning for ruptured ulcer in the distal gastric antrum with associated small volume pneumoperitoneum and hemoperitoneum.
Stigmata of chronic bladder outlet obstruction related to prostatomegaly with multiple bladder diverticula.
Discussion