(Radiology. 1999;210:417-418.)
© RSNA, 1999
Case 11
Patrick M. Rao, MD1
1 Department of Radiology, Massachusetts General Hospital, 32 Fruit St, Boston, MA 02114.
Index terms: Diagnosis please
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A 50-year-old man presented to our emergency department complaining of gradually worsening pain on the right side of the abdomen of 12 hours duration. His pain was initially periumbilical but then localized to the right of the midabdomen. There was associated anorexia, nausea, and five episodes of bilious vomiting. There was no diarrhea, constipation, fever, chills, or other symptoms. The patient denied trauma to the abdomen or ingestion of a foreign body.
At physical examination, the patient was tender to palpation in the right upper and lower abdominal quadrants, with associated rebound tenderness and guarding. Psoas and Rovsing signs were elicited. Laboratory values were remarkable for a white blood cell count of 15,900/mm3. The patient underwent abdominopelvic computed tomography (CT)(Figure), a diagnosis was made, and the patient was sent for emergent laparotomy.
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Figure 1a. Selected sequential axial images from an abdominopelvic CT examination performed with contrast material administered through the colon only. Images are cranial to caudal.
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Figure 1b. Selected sequential axial images from an abdominopelvic CT examination performed with contrast material administered through the colon only. Images are cranial to caudal.
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Figure 1c. Selected sequential axial images from an abdominopelvic CT examination performed with contrast material administered through the colon only. Images are cranial to caudal.
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Figure 1d. Selected sequential axial images from an abdominopelvic CT examination performed with contrast material administered through the colon only. Images are cranial to caudal.
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Footnotes
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Address reprint requests to the author, Lansing Radiology Associates, Sparrow Hospital, 271 Woodland Pass, Suite 120, East Lansing, MI 48823.
Submit the most likely diagnosis to dxplease@rsna.org (use only for submission of diagnosis). Include case number, your name (as you would want it to appear in the journal), address, phone and fax numbers. Only one name and one diagnosis per e-mail submission. Multiple diagnoses, multiple submissions, submissions without a case number will not be considered. Deadline: April 15, 1999. Answer will appear in the June issue. Authors wishing to submit cases for Diagnosis Please should first write to the Editor to obtain approval for the case and further information.
Received June 9, 1998;
revision requested June 30, 1998; revision received July 16, 1998;
accepted August 17, 1998.
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