Findings
Lower chest
- Mild dependent bilateral lower lobe atelectasis/scarring
- Trace pleural effusions
- Posterior left pleural calcification
- Small hiatal hernia with diffuse thickening and enlargement of the esophagus with pneumatosis
- Aortic valve and mitral annular calcification
- Coronary artery calcification
Abdomen/Pelvis
- Extensive pneumatosis involving the stomach, small bowel, and large bowel with portal venous gas
- Multiple mildly dilated loops of small bowel with a relative transition point in the right lower quadrant
- Low attenuation 1.6 cm left adrenal nodule, likely an adenoma
- Heterogeneous mass arising from the upper pole of the left kidney measuring 5 x 5 cm
- Partially calcified lobulated mass in the small bowel mesentery in the right lower quadrant measuring 3 x 2 cm
- Ill-defined soft tissue about the distal abdominal aorta and about the right common iliac artery
- Atherosclerotic calcification of the abdominal aorta and branch vessels without aneurysm
- Small left bladder diverticulum and tiny right bladder diverticulum
- Mild prostatomegaly with nonspecific prostate calcifications
- Enlarged left inguinal lymph node measuring 1.7 cm in short axis
MSK
- Aggressive-appearing lytic lesions involving the right iliac wing, left pubic root and superior pubic ramus, and left inferior pubic ramus with associated pathologic fractures and periosteal reaction
- Polyarticular degenerative changes
- Osteopenia
Diagnosis
Pneumatosis
Portal venous gas
Sample Report
Extensive pneumatosis involving the stomach, small bowel, and large bowel with portal venous gas concerning for bowel ischemia. No pneumoperitoneum. Pneumatosis extends from the stomach into the lower thoracic esophagus.
Left upper pole renal neoplasm with likely metastatic lesions involving the right iliac wing, left pubic root and superior pubic ramus, and left inferior pubic ramus with associated pathologic fractures and periosteal reaction.
Right mesenteric mass, ill-defined para-aortic nodal tissue, and enlarged left inguinal node could represent additional sites of metastatic disease or could relate to a second primary neoplasm.
Given the relative transition point in small bowel caliber near the right lower quadrant mesenteric mass, small bowel obstruction as an inciting factor for bowel ischemia is a consideration.
Discussion