Demographics:
87 years old, Male
Indication:
Altered mental status, abdominal distension
Findings
Lower chest
- Dependent bilateral lower lobe airspace consolidation and groundglass opacities with debris filling multiple bilateral lower lobe bronchi
- Partially imaged surgical changes of median sternotomy, CABG and aortic valve replacement
- Heavy coronary artery calcification
- Mild cardiomegaly
- Posterior left pleural calcification
Abdomen/Pelvis
- Large bowel is distended with gas and formed stool from the cecum to the sigmoid colon with apparent transition point in the distal sigmoid colon
- Sigmoid colon is redundant, but does not take the expected configuration of sigmoid volvulus
- Abnormal bowel rotation with reversal of the usual SMA/SMV relationship
- Liver measures 20 cm in craniocaudal span with Riedel's lobe morphology
- Right adrenal calcification without discrete nodule/mass, likely sequela of prior infection or hemorrhage
- Nonspecific calcification in the gastrosplenic ligament
- Atherosclerotic calcification of the abdominal aorta and branch vessels without aneurysm
- Prostatomegaly
MSK
- No acute findings
- Polyarticular degenerative changes
- Osteopenia
Diagnosis
Large bowel obstruction
Sample Report
Findings concerning for large bowel obstruction with possible transition point in the distal sigmoid colon, which could represent a stricture (including neoplastic and inflammatory etiologies) or recently devolvulized bowel segment. No evidence of volvulus or vascular compromise at this time. Of note, the patient appears to have abnormal bowel rotation, which may predispose to volvulus.
Dependent bilateral lower lobe airspace disease, which is particularly concerning for aspiration given debris filling bilateral lower lobe bronchi.
Discussion