Demographics:
67 years old, Male
Indication:
Generalized abdominal pain
Findings
Lower chest
- Mild dependent atelectasis
Abdomen/Pelvis
- Dilated segment of sigmoid colon in the central abdomen with mural thickening, hypoenhancement, and adjacent mesenteric fat stranding
- Abrupt upstream and downstream caliber changes with the afferent and efferent bowel segments adjacent to each other in the left lower quadrant
- No swirling of the sigmoid mesentery
- No pneumatosis, portal venous gas, or pneumoperitoneum
- Small volume free intraperitoneal fluid layering in the anatomic pelvis and tracking into the left inguinal canal without loculated collection
- Fluid attenuation 2.5 cm structure in hepatic segment IVb, compatible with a cyst
- Additional scattered subcentimeter hepatic hypoattenuating lesions, which are too small to characterize
- 2 cm structure in the spleen with irregular peripheral enhancement, likely a hemangioma
- Atherosclerotic calcification of the abdominal aorta and branch vessels without aneurysm
MSK
- No acute findings
- Polyarticular degenerative changes
Diagnosis
Sigmoid volvulus
Sample Report
Findings concerning for sigmoid volvulus, although there is no swirling of the sigmoid mesentery. Closed-loop obstruction related to an adhesive band is an alternative consideration. Hypoenhancement of the involved loop raises concern for developing bowel ischemia. Recommend surgical evaluation.
Discussion