Wk 4, Case 4 - Review

EXAM: CT Abdomen and Pelvis W/ IV Contrast

INDICATION: 5-year-old male with trauma.

TECHNIQUE: CT imaging of the abdomen and pelvis was obtained after the administration of IV contrast. Coronal and sagittal reformats were obtained for greater anatomic detail.

FINDINGS:

The lung bases are clear. There is no pleural effusion. Visualized portions of the mediastinum appear normal.

In the abdomen, the liver is of normal size and the parenchyma is without focal lesions. There is no intra- or extrahepatic biliary ductal dilatation. The gallbladder is without wall thickening, calcified gallstones, or pericholecystic fluid. The pancreas demonstrates uniform enhancement without inflammatory changes. The spleen is normal in size without focal lesion. The adrenal glands are normal in appearance.

The kidneys demonstrate normal enhancement without focal cystic or solid lesion. No hydronephrosis or hydroureter. The urinary bladder is normal in appearance. The visualized reproductive organs are normal for patient's age.

There is a large intramural hematoma at the 2nd/3rd portions of the duodenum, causing narrowing of the lumen and proximal dilatation.

The remainder of the bowel is normal in caliber without wall thickening. The appendix appears normal. No focal fluid collection is seen. There are no pathologically enlarged lymph nodes. There is mild free pelvic fluid, but no focal fluid collection.

There is a normal appearance of the aorta and its major branches, and a normal appearance of the IVC.

The abdominal wall soft tissues are normal. There are no acute bony abnormalities.

IMPRESSIONS:

Duodenal hematoma, with mild upstream duodenal dilatation. Mild associated peritoneal inflammatory free fluid.
Otherwise normal appearance of the abdomen and pelvis.

EXAM: Upper GI Series

INDICATION: 5-year-old male with history of trauma.

TECHNIQUE: Fluoroscopic images were obtained during the administration of liquid barium by mouth. Contrast was observed extending into the proximal small bowel.

FINDINGS:

The esophagus is normal in course and caliber, without intrinsic or extrinsic abnormality appreciated. The stomach is normal in configuration.

There is persistent luminal narrowing along the second and third portion of the duodenum, consistent with extrinsic mass effect with minimal dilatation of bowel proximal to the narrowing and mild subjective delayed emptying.

The ligament of Treitz is normal in position. There is no demonstrated gastroesophageal reflux.

IMPRESSIONS:

Findings consistent with large duodenal hematoma involving the second and third portions of the duodenum, with mild obstruction.