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Case #15

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Demographics: 75 years old, Male
Indication: Hypotension, rectal bleeding

Findings

Lower chest

  • Scattered groundglass opacities in the left lower lobe and lingula
  • Mild dependent atelectasis
  • Trace right greater than left pleural effusions
  • Heavy coronary artery calcification

Abdomen/Pelvis

  • Mural thickening of the splenic flexure of the colon extending into the proximal descending colon with mild pericolonic fat stranding
  • Intermediate attenuation 2.5 cm round structure in the upper pole of the right kidney with an enhancing nodular component along its inferomedial margin
  • Left upper pole renal cyst and additional scattered bilateral renal hypoattenuating lesions which are too small to characterize
  • Subcentimeter hypoattenuating lesion in hepatic segment 5, which is too small to characterize
  • Mild circumferential bladder wall thickening
  • Prostatomegaly
  • Atherosclerotic calcification of the abdominal aorta and branch vessels without aneurysm
  • Prior lower ventral abdominal wall hernia repair

MSK

  • No acute findings
  • Polyarticular degenerative changes
  • L4-S1 posterior spinal fusion hardware

Diagnosis

Ischemic colitis

Sample Report

Short segment colonic mural thickening centered on the splenic flexure which given the clinical history and underlying vascular disease raises concern for ischemic colitis, although infectious/inflammatory colitis could have a similar appearance. No pneumatosis or portal venous gas.

Solid enhancing mass in the upper pole of the right kidney concerning for neoplasm. Recommend nonemergent renal protocol MRI for further evaluation.

Scattered groundglass opacities in the left lower lobe and lingula, concerning for aspiration pneumonitis or pneumonia.

Mild circumferential bladder wall thickening likely relates to chronic outlet obstruction in the setting of prostatomegaly. Consider correlation with urinalysis if there is clinical concern for cystitis.

Discussion

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