bung cap ct.

Supine and upright plain radiographs of the abdomen show a relative paucity of bowel gas on the left side of the abdomen There is mild irregularity and thickening of the folds in a loop of bowel in the right lower quadrant (arrow) Several gas-fluid levels are visible in this region (arrows) No appendicolith or free intraperitoneal air is shown These findings are consistent with an inflammatory process in the right lower quadrant resulting in a localized small bowel ileus Contrast enhanced CT of the abdomen demonstrates a moderate-sized left subcapsular hematoma which compresses the renal parenchyma (arrow) The left nephrogram is slightly diminished and there is no excretion of contrast by the left kidney A wedge-shaped low density laceration is seen in the anterior midpole of the left kidney (arrow) There is mild infiltration of the left perinephric fat (arrow), but no large perinephric hematoma is seen Findings: The gallbladder wall is thickened with inflammatory changes surrounding the gallbladder and fluid seen extending into the right paracolic gutter There is a simile hepatic cyst within the posterior segment of the right lobe There is no intra- or extrahepatic biliary ductal dilatation seen There is thickening of the sigmoid colon with numerous diverticula, but there is no evidence of diverticulitis The uterus and appendix are surgically absent The right adrenal gland is slightly enlarged Otherwise, the kidneys, left adrenal gland, pancreas, lung bases and urinary bladder are unremarkable Diagnosis: Acute Cholecystitis Findings: The appendix is enlarged with inflammatory changes within the surrounding soft tisuues consistent with appendicits Small fluid collections are present adjacent to the appendix consistent with perforation Large amount of peritoneal fluid with a few air bubbles Diagnosis: Appendiceal Abscess Findings: There is a layering density present in the gallbladder with apparent discontinuation in the gallbladder wall Pericholecystic fluid is present with free intraperitoneal fluid around the liver also No air is present in the gallbladder Wispy infiltrative changes are present in the adjacent intraperitoneal fat consistent with inflammation Diagnosis: Cholecystitis (CT&US) Findings: There is a high-grade colonic obstruction at the level of the splenic flexure There is suggestion of a small soft tissue mass in this area There is a small right pleural effusion with some atelectasis in the right lower lobe The primary service was notified of the results immediately following the examination Diagnosis: Obstructing Colon CA Findings: 1) Gallbladder wall thickening, gallbladder sludge and possibly cholelithiasis, mucosal irregularity, and severe strandy change surrounding the gallbladder which all indicate cholecystitis and probably gallbladder necrosis in this patient with right upper quadrant pain and fever 2) Inflammatory change in adjacent hepatic flexure with no evidence of bowel obstruction 3) Bibasilar atelectasis/infiltrate with bilateral small pleural effusions Infection in these areas cannot be excluded and recommend correlation clinically and with recent plain films of the chest Diagnosis: Cholecystitis Findings: Bibasilar air space consolidation which probably represents pneumonia Large amount of ascites Several ill defined low attenuation areas in the spleen and left kidney which may represent infarction or loci of infection Dilated large and small bowel down to the level of the proximal sigmoid If clinically indicated a barium enema might be helpful to exclude obstruction Peritoneal enhancement consistent with peritonitis Diagnosis: Ischemic & Perforated Bowel Diagnosis: CMV Colitis with Ischemia Findings: There is severe, nodular colonic wall thickening extending from the cecum all the way to the rectum which is more extensive proximally A moderate amount of ascites is present throughout the abdomen and pelvis There is a fluid loculation just inferior to the lateral segment of the left lobe of the liver Patency of the vascular cannot be determined due to lack of intravenous contrast Discussion: Both infectious and ischemic colitis can produce the above CT findings CMV colitis can produce colonic wall thickening CMV colitis may also show a "target sign" due to submucosal edema CMV infection often extends across the ileocecal valve to involve the ileum Severe CMV colitis may result in distention and even perforation Findings in ischemic colitis may be similar "Thumbprinting" may be seen in the colonic wall mucosa representing heaped-up, inflamed areas of mucosa More advanced cases of ischemic colitis result in linear or punctate collections of gas in the bowel wall This gas may extend into the mesenteric and portal venous systems Diagnosis: CMV Colitis with Ischemia Findings: Cholecystitis with perforation and free fluid around the lateral aspect of the liver Diagnosis: Cholecystitis Findings: Proximal small bowel intussusception with possible lead point Suggest further evaluation as discussed above Marked fatty infiltration of the liver No evidence of cirrhosis or pancreatitis Bibasilar minimal lung changes as described and discussed above Diagnosis: small bowel intussusception; fatty infiltration of the liver Findings: 1.Cholecystitis with perforation Right pleural effusion with associated atelectasis/consolidation Diagnosis: 1.Cholecystitis Acute appendicitis Distal small bowel obstruction with low-density foreign body in the mid ileum Small bowel obstruction with multiple air fluid levels Small bowel obstruction upright view with NGT in stomach Large and small bowel dilation There is also a lateral decubitus view Pneumointestinalis in a neonate There is a close up view demonstrating the bowel wall air Pneumobilia after passage of a gallstone Take a good look at the liver where the biliary tract is outlined by air Gas in the biliary tree Gas in the biliary tree Findings There are linear air densities in a branching pattern overlying the liver This is the appearance of gas within the biliary tree The enlarged view shows this more clearly The main differential for this appearance is gas within the portal veins, an altogether more ominous sign The gas then tends to be more peripheral and fragmented, whereas gas in the biliary tree frequently outlines the common bile duct and major branches gas may sometimes also be visible in the gall bladder There are several causes for this appearance: •Passage of a stone through the common bile duct may allow reflux of air •Fistula: Most commonly due to inflammation secondary to stones The stone may pass into the duodenum, or into the transverse colon In the former, the stone often impacts in the distal small bowel causing small bowel obstruction (gallstone ileus), and the combination of obstruction and biliary gas should suggest this (whether the stone is visible or not) Tumour may also cause a fistula •Infection: emphysematous cholecystitis produces air in the gallbladder, and this may also outline the biliary tree It is commoner in diabetics •Previous instrumentation or surgery: ERCP and sphincterotomy for bile duct stones is a common cause, and biliary bypass surgery (eg choledochojejunostomy) produces a similar appearance Leaking abdominal aortic aneurysm Findings The film shows calcification within the wall of the abdominal aorta The lateral margin of the calcification is well to the left, suggesting the aorta is aneurysmal In addition, the right iliopsoas outline is obliterated, a sign of leakage or rupture Findings: The appendix is mildly dilated with a thickened appendiceal wall Mild strandy inflammatory changes are seen surrounding the appendix No periappendiceal fluid collections are present No free air or fluid is seen in the abdomen or pelvis Diagnosis: Appendicitis Discussion: CT findings in early or mild appendicitis include thickening and dilatation of the appendix with adjacent inflammatory changes More severe cases will present with a ruptured appendix and a periappendiceal abscess A calcified appendicolith can be seen in about 25% of cases Findings: The liver is cirrhotic in configuration and diffusely heterogeneous in enhancement There is mildly patchy enhancement involving all hepatic lobes and segments There is patchy dilatation of the intrahepatic biliary ducts The spleen is enlarged Diagnosis: Primary Sclerosing Cholangitis Discussion: Primary sclerosing cholangitis (PSC) may be associated with underlying conditions such as ulcerative colitis and retroperitoneal fibrosis but can be an isolated finding PSC may progress to cirrhosis and protal hypertension Characterisitc findings with PSC include nonuniform biliary dilatation with beaded areas of alternating stenosis and dilation The nonuniformity and potentially focal nature of PSC distinguishes it from other causes of uniform biliary ductal dilatation Secondary causes of sclerosing cholangitis include prior biliary surgery, choledocholithiasis, carcinoma, or infection ...Contrast enhanced CT of the abdomen demonstrates a moderate-sized left subcapsular hematoma which compresses the renal parenchyma (arrow) The left nephrogram is slightly