0:00

Alright, here we have a contrast-enhanced

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CT scan of the abdomen and pelvis.

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Um, again, in that portal venous phase of imaging,

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as we come down, we can already see that the liver

0:10

is a little lower in attenuation than the spleen.

0:12

This is probably due to some degree

0:14

of fatty infiltration of the liver.

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Kind of a common entity, uh, that we see

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frequently in our emergency department.

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And as we progress inferiorly, you can actually

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see a little region here within the right lobe

0:25

of the liver of even decreased attenuation.

0:27

That's also a really common location

0:29

for focal fatty infiltration.

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A location where, um, the fat will even be

0:33

deposited more within a slightly fatty liver.

0:35

So that is within normal limits.

0:37

In patients in this category, but

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oh, look at the right upper quadrant.

0:42

In the porta hepatis, we can see that

0:43

there is a calcified gallstone in a bad

0:46

neighborhood in the neck of the gallbladder.

0:47

That gallbladder is thickened with a

0:50

thickened wall, and there's already peri-

0:52

cystic fluid outlining the gallbladder as well.

0:54

And as we come down, we can see a significant amount

0:57

of pericolic, cystic stranding, and fluid all

1:00

in that region, again, adjacent to the transverse

1:03

colon and coming around the gallbladder fundus.

1:06

Progressing down on the patient,

1:08

we can also see a number of renal cysts.

1:10

That's a pretty common finding in our patient

1:12

population as they age as well, and progressing

1:15

all the way down into the lower quadrant.

1:19

We will come upon what is called a pessary.

1:22

That is actually a device utilized for, uh,

1:25

aging patients in order to stop uterine prolapse.

1:29

So, um, we can look at that again on the coronal

1:31

when we're looking at the coronal images.

1:32

Here are the coronal images.

1:34

You can see that gallstone is just wedged tightly

1:36

in that gallbladder neck, causing problems, causing

1:39

the gallbladder to be distended and obstructed.

1:42

Um, the gallbladder is very angry in appearance

1:46

with the fluid and the pericholecystic stranding.

1:49

But those are the major findings in this case.

1:51

We look at the common bile duct on all CT

1:53

scans to make sure that we don't see anything

1:55

obstructing within the common bile duct.

1:57

We want to make sure the patient hasn't dropped

1:58

a stone, and again, that pessary down in the

2:02

pelvis, if that's what you're concerned about.

2:04

You can always Google that.

2:05

They are extreme in appearance, I have to say.

2:08

Besides that, I don't see any other acute problems.

2:10

This patient is off to general surgery

2:13

and will be going for a cholecystectomy.