Wk 1, Case 1 - Review

Patient History

82-year-old male presents to the emergency department with abdominal pain and altered mental status.

TECHNIQUE:

CT of the abdomen and pelvis with intravenous contrast.

COMPARISON: None available.

FINDINGS:

LOWER THORAX: Mild bronchial wall thickening. There is a small left pleural effusion. There is mosaic attenuation of bilateral lower lobes and the right middle lobe. Left basilar atelectasis. There is multichamber cardiomegaly. There is multivessel coronary artery calcification. There are atherosclerotic changes to the aorta and arch vessels. There is calcification of the aortic valve.

HEPATOBILIARY: There is portal venous air primarily in segment IVb. No focal hepatic lesions.

The gallbladder is dilated measuring 13 cm in length and 4.7 cm in width with a large peripherally calcified gallstone at the neck which measures 3 cm x 5 cm. There is air tracking along the entire wall of the gallbladder.

SPLEEN: No splenomegaly.

PANCREAS: There is diffuse fatty infiltration of the pancreas. No focal masses or ductal dilatation.

ADRENALS: No adrenal nodules.

KIDNEYS/URETERS: Status post left nephrectomy. Unchanged numerous right renal cysts. No hydronephrosis, stones, or solid mass lesions.

PELVIC ORGANS/BLADDER: There is circumferential wall thickening of the bladder with evidence of intraluminal air which may be related to recent instrumentation or a decompressed bladder.

PERITONEUM / RETROPERITONEUM: No free air or fluid.

LYMPH NODES: No lymphadenopathy.
VESSELS: Severe atherosclerotic calcification of the abdominal aorta and its branch vessels.

GI TRACT: No free air seen in the abdomen. No evidence of bowel obstruction. No wall thickening. Diverticulosis without diverticulitis. Normal appendix.

BONES AND SOFT TISSUES: There is a mixed lytic and sclerotic lesion within L2 vertebral body, likely corresponding to biopsy-proven plasmacytoma, with increased inferior endplate collapse compared to 2016. There is partial sacralization of the L5 vertebral body. Degenerative changes throughout the spine. No new suspicious lytic or blastic lesions.

IMPRESSION:

1. Emphysematous cholecystitis with a large gallstone at the neck of the gallbladder.

2. Small left pleural effusion.

3. Mixed lytic and sclerotic lesion within L2 vertebral body, likely correspond to biopsy-proven plasmacytoma, with increased inferior endplate collapse compared to 2016.