51-year-old female with history of rheumatoid arthritis and status post duodenal ulcer cauterization in outside hospital presenting with abdominal pain vomiting and hematemesis ABDOMEN:LUNG BASES: Small amount of bilateral pleural effusions and dependent atelectasis.LIVER, BILIARY TRACT: Pneumobilia. Two punctate air bubbles near the common bile duct best seen on image number 47 on coronal series likely represent air in the cystic duct stump, however, possibility of free air cannot be entirely excluded. SPLEEN: Wedge-shaped nonenhancing area in the superior pole of the spleen measuring 2.6 x 2.8 cm and is consistent with an infarct. Superior pole of the spleen adjacent to the infarct demonstrates heterogeneous enhancement. The etiology is unknown but may be secondary to ischemia and much less likely an infiltrating neoplastic process. Follow-up imaging can be helpful in a month for further evaluation.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic kidneys consistent with bases on history of end-stage renal disease. 12 x 12 mm hypodense lesion in the upper pole of the left kidney contains linear enhancements. This represent a thin septations, however, a solid lesion cannot be entirely excluded. There are other numerous, small hypodense lesions in both kidneys, some which contain increased density. These are too small to fairly characterize.RETROPERITONEUM, LYMPH NODES: Right retrocrural borderline enlarged lymph node measuring 10 x 7 mm or 20, series 5.BOWEL, MESENTERY: Proximal small bowel loops are minimally dilated measuring up to 2.7-cm. In the right lower quadrant, and distal small bowel loops are decompressed. Colonic loops are distended with fluid. These findings may be secondary to mild partial small bowel obstruction.The wall of the stomach and duodenum is definitive thickened.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount ascites.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Severe degenerative changes affecting the joints. Small amount of fluid around the hip joint anteriorly demonstrating possible loculations. Further evaluation with MRI may be helpful.OTHER: Decubitus ulcer with a subcutaneous abscess in the pelvis measuring 10 x 14 mm adjacent to the decubitus ulcer.
Pneumobilia. The etiology is unknown. Punctate amount of air near the common bile duct may represent air in the cystic duct stump, however, although the possibility of free air is low, this cannot be entirely excluded.Splenic infarct in the upper pole of the spleen. Follow-up imaging in one month is recommended to further evaluate the splenic tissue surrounding the infarct.Bilateral small hypodense lesions in atrophic kidneys. These are incompletely evaluated with this single phase study. Follow-up imaging in 6 Maas is recommended especially for the evaluation of the left upper pole complex lesion.Mild partial small bowel obstruction. Gastroduodenal wall thickening.Decubitus ulcer with subcutaneous abscess.Left hip joint fluid demonstrating possible loculations. Further evaluation with MRI may be helpful to exclude septic arthritis.