History of right lower quadrant pain with large pelvic phlegmon seen on recent CT. ABDOMEN:LUNG BASES: Subcentimeter left lower lobe pulmonary nodule better seen on recent CT.LIVER, BILIARY TRACT: There is mild dilation of the common bile duct up until the level of the ampulla, measuring up to 7 mm. There is associated mild intrahepatic ductal dilatation as well. No focal hepatic lesions are identified.SPLEEN: No significant abnormality noted.PANCREAS: The pancreatic duct is diffusely dilated up until the ampulla, measuring up to 6 mm. No distinct pancreatic lesions are identified.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Large pelvic abscess as described below. Round areas of signal abnormality within the myometrium likely reflect uterine fibroids. There is no abnormal thickening of the endometrial stripe. To the right of and apparently distinct from the uterus and ovaries, there is a well-defined round structure measuring 4.3 x 3.7 cm which demonstrates decreased T2 signal, intermediate T1 signal, and heterogeneous enhancement which is nonspecific.BLADDER: No significant abnormality noted.LYMPH NODES: Mild retroperitoneal lymphadenopathy which is nonspecific but may be reactive. BOWEL, MESENTERY: The distal appendix is dilated with surrounding inflammatory changes compatible with ruptured appendicitis. There is a large associated pelvic abscess as described below.BONES, SOFT TISSUES: Degenerative changes affect the spine and hip joints.OTHER: There is a large, multiloculated fluid collection in the pelvis with peripheral enhancement compatible with an abscess. The largest single locule measures approximately 4.8 x 4.6 cm. In total, the abscess measures approximately 8.5 x 11.0 cm including adjacent surrounding inflammatory changes.
1.Findings compatible with ruptured appendicitis with large multiloculated pelvic abscess/phlegmon.2.Nonspecific 4.3 cm structure within the pelvis which appears distinct from the uterus and ovaries. Differential considerations include a pedunculated fibroid or a fibrous tumor, though evaluation is limited by aforementioned pelvic inflammatory process. Follow-up imaging when the acute episode has resolved is recommended for further evaluation.3.Dilation of the common bile duct and pancreatic duct to level of ampulla which may reflect ampullary stricture or lesion. ERCP is recommended for further evaluation if clinically indicated.Presence of an abscess was discussed by radiology on-call resident with the surgical service at 12:31 AM on 8/28/2016.