61-year-old female with poor PO intake. Evaluate for any small bowel abnormalities. ABDOMEN: Mild dependent right basilar atelectasis.LIVER, BILIARY TRACT: There is a mildly lobulated T2 hyperintense non- focus in the hepatic dome measuring 3.9 x 2.5 cm. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is a T2 hyperintense, T1 hypointense, nonenhancing 9 mm focus in the left mid pole compatible with a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The stomach is severely distended. The small bowel is diffusely distended measuring up to 3.2 cm. There is increased ileal folds. A decrease in the number of jejunal folds is equivocal in this case. Large stool burden is noted.BONES, SOFT TISSUES: Scoliosis.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Gastric and diffuse small bowel distention, consistent with diffuse adynamic ileus. The dilated ileum has a "hidebound appearance" with narrowed separation of the valvulae conniventes (despite the degree of bowel lumen dilatation) with normal-appearing thickness of the folds. Somewhat more than expected intraluminal fluid may reflect hypersecretion. Constellation of findings is especially suspicious for scleroderma (also given patient's history of interstitial lung disease), although other differential considerations such as celiac sprue cannot be entirely excluded. In the latter case there is classically jejunization of the ileum with increased folds seen; a decrease in the number of jejunal folds is equivocal in this case. Correlation with patient's clinical history and laboratory values recommended.2.Hepatic dome cystic lesion. Differential considerations include a simple cyst versus biliary cystic neoplasm. Hemangioma is considered much less likely.