Demographics:
68 years old, Male
Indication:
chest, abdomen, and back pain
Findings
Chest
- No acute findings
- No evidence of thoracic aortic aneurysm or dissection
- Subcentimeter calcified granuloma adjacent to the right major fissure
- Thin-walled pulmonary cyst in the right lower lobe
- Small hiatal hernia
Abdomen/Pelvis
- 2.3 cm peripherally calcified structure likely representing a gallstone in the mid small bowel with upstream small bowel dilation, mural thickening, and submucosal edema
- Distally, the small bowel and colon are nondistended
- No convincing pneumatosis
- Gallbladder is collapsed with wall thickening, intraluminal gas, and demonstration of a fistulous connection to the adjacent duodenum
- Trace pneumobilia
- Inflammatory fat stranding about the above described loops of small bowel as well as surrounding the gallbladder
- No pneumoperitoneum or loculated intraabdominal fluid collection
- Scattered colonic diverticula
- Hepatomegaly with hepatic steatosis
MSK
- No acute findings
Diagnosis
Gallstone ileus
Sample Report
Findings are consistent with gallstone ileus. A 2.3 cm peripherally-calcified gallstone is identified in the mid small bowel with associated upstream small bowel dilation and inflammatory changes. Superimposed ischemia is not excluded, though there is no convincing pneumatosis or portal venous gas.
Decompressed gallbladder with associated inflammatory changes and demonstration of a cholecystoduodenal fistula.
Discussion