Demographics:
80 years old, Male
Indication:
Abdominal pain, lactic acidosis
Findings
Lower chest
- Small hiatal hernia
- Mildly patulous, fluid-filled lower thoracic esophagus
- Aortic valve and coronary artery calcification
- Moderate centrilobular emphysema
- Volume loss in the right lower lobe with dependent opacities and mild bronchiectasis
Abdomen/Pelvis
- Extensive portal and mesenteric venous gas
- Pneumatosis involving multiple loops of small bowel in the left hemiabdomen
- Extensive mural thickening involving segments of the ascending colon, descending/sigmoid colon, and rectum
- Fat stranding in the sigmoid mesocolon
- Percutaneous gastrostomy tube with retention flange in the gastric antrum
- Cholelithiasis
- Trace abdominopelvic free fluid without free air or loculated collection
- Atherosclerotic calcification of the abdominal aorta and branch vessels with mild ectasia of the infrarenal abdominal aorta measuring 2.6 cm in AP diameter
MSK
- No acute findings
- Polyarticular degenerative changes
- Partially imaged left total hip arthroplasty
Diagnosis
Pneumatosis and portal venous gas
Sample Report
Extensive portomesenteric venous gas with pneumatosis involving multiple loops of small bowel in the left hemiabdomen, concerning for small bowel ischemia.
Multisegmental mural thickening of the colon and rectum, concerning for proctocolitis which may relate to infectious, inflammatory, or ischemia etiologies.
Small hiatal hernia with a patulous, fluid-filled esophagus, which places the patient at risk for aspiration.
Findings in the right lower lobe likely relate to prior/chronic infection or inflammation although superimposed aspiration or pneumonia is difficult to exclude.
Discussion