Monday, January 17, 2011

Don't Miss It

An 80 year old smoker with coronary artery disease s/p 2 vessel coronary artery bypass graft, hyperlipidemia, and congestive heart failure presents to the emergency department with rapid onset severe periumbilical abdominal pain, nausea, and vomiting. There is mild abdominal distension but no rebound, tenderness, or guarding. The patient's mental status is slightly worse than baseline. A rectal exam is positive for fecal occult blood. A CT is shown below.

Challenge: What's your diagnosis?

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1 comment:

Craig Chen said...

Don't Miss It

This is acute mesenteric ischemia. The CT image shows gas in the portal venous system (blue circle), lack of contrast in the superior mesenteric artery due to thrombosis (blue arrow), and extensive pneumatosis intestinalis (red arrows).

Sources: UpToDate; LearningRadiology.