Demographics:
67 years old, Male
Indication:
Diffuse abdominal pain
Findings
Lower chest
- Mild dependent right lower lobe atelectasis
- 4 mm right lower lobe pulmonary nodule
- Mild widespread bronchial wall thickening
- Mild centrilobular emphysema
- Coronary artery calcification
- Circumferential mural thickening of the lower thoracic esophagus
Abdomen/Pelvis
- Multiple dilated loops of small bowel, measuring up to 5 cm in diameter, with transition to normal caliber in the distal ileum
- Stomach is markedly distended with gas and fluid
- Mural hypoenhancement of multiple loops of small bowel in the right lower quadrant and mild mucosal hyperenhancement of multiple loops of proximal and mid small bowel
- Colon is decompressed with widespread mild mucosal hyperenhancement
- No pneumatosis or portal venous gas
- Severe atherosclerotic disease with occlusion of the abdominal aorta below the level of the SMA, high grade stenosis versus focal occlusion of the proximal celiac artery, and high grade stenosis at the origin of the SMA
- Nonopacification of the bilateral renal arteries, IMA, and bilateral iliac arterial branches
- Left common iliac artery stent is occluded
- Marked heterogeneous enhancement of the hepatic parenchyma with multiple wedge-shaped hypoenhancing areas, particularly in the left hepatic lobe
- Heterogeneous splenic enhancement
- Minimal patchy left and no appreciable right renal parenchymal enhancement
- Trace free fluid layering in the anatomic pelvis
- Prostatomegaly with coarse prostatic calcifications
MSK
- No acute findings
- Partially imaged dynamic hip screw fixation of the proximal left femur
- Polyarticular degenerative changes
- Osteopenia
Diagnosis
Ischemic bowel
Sample Report
Occlusion of the abdominal aorta below the level of the SMA with high grade stenoses at the origins of the celiac artery and SMA and findings concerning for ischemia involving multiple loops of small bowel in the right lower quadrant as well as solid organ ischemia involving the liver, spleen, and bilateral kidneys.
Mucosal hyperenhancement of additional loops of small bowel and the colon is nonspecific and may relate to ischemia or inflammation.
Findings concerning for high grade small bowel obstruction with transition point in the distal ileum.
Discussion