Air and Fluid on Air and Fluid on Computed TomographyComputed Tomography

Tinika MontgomeryTinika MontgomeryUniversity of Virginia School of MedicineUniversity of Virginia School of Medicine

February 24, 2006February 24, 2006

HistoryHistory

62 yo immunosuppressed M with h/o EtOH cirrhosis, three 62 yo immunosuppressed M with h/o EtOH cirrhosis, three months s/p orthotopic liver transplant, presented with months s/p orthotopic liver transplant, presented with N/V, intermittent colicky abdominal pain that began two N/V, intermittent colicky abdominal pain that began two days PTA. Patient admitted flatus and last BM three days PTA. Patient admitted flatus and last BM three days PTA. days PTA.

On admission, vital signs were WNL and the exam was On admission, vital signs were WNL and the exam was unremarkable. CXR, AXR, EKG and labs obtained were unremarkable. CXR, AXR, EKG and labs obtained were unremarkable. An NGT was placed yielding 200cc of unremarkable. An NGT was placed yielding 200cc of fluid. fluid.

Patient became obstipated with abdominal distention during Patient became obstipated with abdominal distention during hospitalization, and CT of the abdomen and pelvis with hospitalization, and CT of the abdomen and pelvis with oral contrast were ordered.oral contrast were ordered.

Radiographic FindingsRadiographic Findings

Right Pleural Effusion:Right Pleural Effusion:Low density signal. Differential dx is pleural Low density signal. Differential dx is pleural

thickening, however the density would be thickening, however the density would be greatergreater

Right Perirectal Abscess:Right Perirectal Abscess:Low density signal suggesting fluid (pus) with a Low density signal suggesting fluid (pus) with a

small black bubble suggesting a gas collection. small black bubble suggesting a gas collection. Differential dx is a cyst, however the gas Differential dx is a cyst, however the gas collection would not be presentcollection would not be present

Right Pleural Effusion

Radiographic FindingsRadiographic Findings

Right Pleural Effusion:Right Pleural Effusion:Low density signal. Differential dx is pleural Low density signal. Differential dx is pleural

thickening, however the density would be thickening, however the density would be greatergreater

Right Perirectal Abscess:Right Perirectal Abscess:Low density signal suggesting fluid (pus) with Low density signal suggesting fluid (pus) with

small black bubbles suggesting gas collection. small black bubbles suggesting gas collection. Differential dx is a cyst, however the gas Differential dx is a cyst, however the gas collection would not be presentcollection would not be present

Right Perirectal Abscess

DispositionDisposition

Patient discharged to home with diagnosis of Patient discharged to home with diagnosis of nausea and vomiting on home medications, nausea and vomiting on home medications, including immunosuppressants. Hospital course including immunosuppressants. Hospital course involved medical management without further involved medical management without further surgical intervention or radiographic study.surgical intervention or radiographic study.

ReferencesReferences

Novelline, Robert. Novelline, Robert. Squire’s Fundamentals of Squire’s Fundamentals of Radiology 5Radiology 5thth Ed Ed. 1997.. 1997.

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PACSPACS

Air and Fluid on Air and Fluid on Computed TomographyComputed Tomography

Tinika MontgomeryTinika MontgomeryUniversity of Virginia School of MedicineUniversity of Virginia School of Medicine

February 24, 2006February 24, 2006