Wk 4, Case 5 - Review

PATIENT HISTORY: Abdominal pain

CT ABDOMEN PELVIS W IV CONTRAST

HISTORY: Abdominal pain.

COMPARISON: None.

TECHNIQUE: CT images of the abdomen and pelvis were obtained after the administration of intravenous contrast.


FINDINGS:

LUNG BASES: There is a small right and trace left pleural effusion with adjacent atelectasis at the lung bases.

HEPATOBILIARY: Unremarkable.

SPLEEN: Unremarkable.

PANCREAS: Unremarkable.

ADRENALS: Nonspecific nodule left adrenal thickening. Right adrenal gland is unremarkable.

KIDNEYS: There is a right renal cyst with additional renal hypodensities too small to characterize. Ill-defined region of decreased attenuation in the interpolar aspect of the right kidney may represent focal pyelonephritis or an infarct.

BOWEL: Wall thickening and intramural edema is noted involving the distal ileum, compatible with an enteritis.

PERITONEUM: Trace free fluid is present. No abscess or pneumoperitoneum is seen.

LYMPH NODES: Unremarkable.

VASCULATURE: There is a filling defect in the distal SMA, compatible with a partially occlusive thrombus.

PELVIS: Anterior bladder wall thickening may be due to underdistention. Given the presence of adjacent fat stranding, the possibility of cystitis could also be considered.

BONES & SOFT TISSUE: No aggressive osseous lesions are detected.


IMPRESSION:

1. Findings compatible with an enteritis involving the ileum as described. Given the findings in the SMA, this likely represents ischemic enteritis.

2. Findings involving the right kidney may represent pyelonephritis or infarct, particularly given the suspected findings of ischemic enteritis.

3. Questionable cystitis.