This condition is generally idiopathic and asymptomatic; however, pathologic findings such as ischemia or necrosis can produce this condition.

OBSERVATION

History:  Fecal impaction; ? free air

Technique:  DX abdomen 1 view supine

The upper portion of the abdomen is not included in the field of view.  Substantial amount of feces is seen in the rectum.  Moderate gas distended bowel loops are noted, with the widest diameter measuring 10 cm in the right lower quadrant.  There appears to be lucency at the walls of the bowels in the right hemiabdomen which may be due to pneumatosis intestinalis.  Degenerative change is seen in the spine.  Dynamic compression screw is noted in the left proximal femur with degenerative change.  Surgical clips are noted in the left upper quadrant.

IMPRESSION

Lucency at the walls of the bowels in the right hemiabdomen which may be due to pneumatosis intestinalis.  While this can be a benign idiopathic finding, it can also be seen with severe pathology such as infection or ischemia.  Possible constipation.  Possible ileus versus bowel obstruction.  Recommend CT scan correlation.

Observation

Clinical History: s/p cardiac arrest.

Technique: DX chest, portable 1 view

ET tube with its tip in the right mainstem bronchus. Suggest retraction by about 5 cm. There is marked cardiomegaly. Opacities are noted bilaterally more on the suprahilar and perihilar regions with air-bronchograms. Followup with PA and lateral chest radiograph is recommended.

Impression

APPARENT MALPOSITION OF ET TUBE, AS DESCRIBED. SUGGEST RETRACTION BY ABOUT 5 CM. MARKED CARDIOMEGALY. FINDINGS IN THE LUNGS POSSIBLY DUE TO PULMONARY EDEMA OR PNEUMONIA. RECOMMEND FOLLOW-UP.

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Observation

Clinical history: Rule out PE, chills, elevated D-dimer

Technique: CT scan of the chest and bilateral lower extremity venogram with intravenous contrast

No CT features of pulmonary embolism in the central pulmonary arteries. However, evaluation of the peripheral subsegmental vessels is limited by a suboptimal bolus of contrast and small peripheral emboli cannot be entirely excluded. The pulmonary arteries are prominent, suggesting an element of possible pulmonary arterial hypertension. Calcified granulomas are noted in the lungs bilaterally. No pleural effusion or pneumothorax is seen. No pericardial effusion is seen. Mild cardiomegaly is noted. Calcified right hilar lymph nodes are noted. The aorta is unremarkable without aneurysm or dissection. Degenerative changes of the spine are noted. The left kidney is severely enlarged with severe hydronephrosis and significant cortical thinning. There are air fluid levels within the left kidney, suggestive of emphysematous pyelonephritis. There is an approximately 9 cm diameter abscess off the upper pole of the left kidney centered on approximately image 163 which at its lower aspect on image number 165 appears to necessitate through the renal capsule and extend through left lateral abdominal wall possibly involving the lateral extra peritoneal abdominal wall musculature. There is a second large abscess which appears to extend from a left medial inferior renal calyx to involve the psoas muscle. This also has associated gas within it consistent with a large abscess necessitating from the kidney to the psoas muscle. A few small bowel loops are prominent, likely representing ileus. Bilateral lower extremity veins are well opacified. No filling defect is noted to suggest deep vein thrombosis.

Impression

Chest CT impression: No Ct features of pulmonary embolism in the central pulmonary arteries. However, evaluation of the peripheral subsegmental vessels is limited by suboptimal bolus of contrast as well as breathing motion artifact and small peripheral emboli cannot be excluded. Correlate clinically. Consider further evaluation with nuclear medicine ventilation perfusion scan.

Abdominal CT report: severe emphysematous pyelonephritis with two large abscess is one which necessitates to the lateral abdominal wall likely extending into the extra peritoneal deep muscle layer. A second appears to necessitate from the lower medial renal calyx to involve the psoas muscle. Follow up recommended. No CT features of deep vein thrombosis.

Further reading:
http://emedicine.medscape.com/article/1236228-overview

Observation

Clinical History: Pain, swelling, ankle and foot fractures

Technique: DX left foot (3 views)

Compared with prior study dated February 2, 2010 (21:03)

The presence of cast material obscures subtle bony detail, limiting the study. At least three well corticated osseous structures posterior to the talus are again seen, unchanged. Partly imaged fractures of the medial and lateral malleolus show no significant interval change and are described in detail in the accompanying ankle films. The mineralization of the visualized bony structures is well maintained. Soft tissue swelling around the ankle joint is again seen and appears unchanged. Compared to the pre-reduction film, a lateral displacement of the second through fifth metatarsals and possibly also of the first metatarsal in relation to the tarsal bones, is now more apparent.

Impression

INTERVAL PLACEMENT OF CAST. LATERAL DISPLACEMENT OF THE SECOND THROUGH FIFTH METATARSALS IN RELATION TO THE TARSAL BONES, AND PROBABLY OF THE FIRST METATARSAL IS NOW MORE APPARENT, SUGGESTIVE OF A LISFRANC DISLOCATION. FURTHER EVALUATION WITH MRI MAY BE OF BENEFIT. OTHERWISE STABLE STUDY OF THE LEFT FOOT.

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Observation

Clinical History: Pre-op

Technique: DX chest 2 views

The cardiomediastinal silhouette appears to be within normal limits. The lungs are hyperexpanded with flatteing of the hemidiaphragms. No acute focal infiltrate or consolidation is seen. There is presence of an air-filled bowel loop, between the liver and right hemidiaphragm, which is usually of no clinical significance.

Impression

CLEAR CHEST. CONSIDER COPD. OTHER FINDINGS AS NOTED ABOVE.

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