Demographics:
72 years old, Male
Indication:
Worsening abdominal pain and distension
Findings
Lower chest
- Mild dependent atelectasis
- Coronary artery calcification
Abdomen/Pelvis
- Large volume pneumoperitoneum with gas and fluid in the lesser sac
- Diffuse colonic wall thickening and mesocolic fat stranding without evidence of bowel obstruction
- Moderate volume abdominopelvic ascites
- Subcentimeter fluid attenuation lesion in the left hepatic lobe, which is too small to characterize
- High density material layering in the gallbladder, likely relating to vicarious excretion of contrast material
- Residual enhancement of both kidneys with excreted contrast material in the collecting systems and bladder, likely related to IV contrast administration from a recent prior study
- 2.5 cm interpolar left renal cyst
- Foley catheter in place with intraluminal bladder gas likely relating to instrumentation
- Extensive atherosclerotic calcification of the abdominal aorta and branch vessels without aneurysm
MSK
- No acute osseous findings
- Thoracolumbar spinal fusion hardware with extensive posttraumatic deformity of the lower thoracic and lumbar spine
- Osteopenia
- Body wall edema
Diagnosis
Duodenal ulcer perforation
Sample Report
Large volume pneumoperitoneum with fluid and gas in the lesser sac, concerning for gastric or duodenal ulcer perforation. Recommend surgical consultation.
Diffuse mural thickening of the colon concerning for colitis, which may relate to infectious (including C. difficile) or inflammatory etiologies.
Moderate volume abdominopelvic ascites.
Discussion