Air and Fluid on Computed Tomography Tinika Montgomery University of Virginia School of Medicine February 24, 2006

History 62 yo immunosuppressed M with h/o EtOH cirrhosis, three months s/p orthotopic liver transplant, presented with N/V, intermittent colicky abdominal pain that began two days PTA. Patient admitted flatus and last BM three days PTA. On admission, vital signs were WNL and the exam was unremarkable. CXR, AXR, EKG and labs obtained were unremarkable. An NGT was placed yielding 200cc of fluid. Patient became obstipated with abdominal distention during hospitalization, and CT of the abdomen and pelvis with oral contrast were ordered.

Radiographic Findings Right Pleural Effusion: Low density signal. Differential dx is pleural thickening, however the density would be greater Right Perirectal Abscess: Low density signal suggesting fluid (pus) with a small black bubble suggesting a gas collection. Differential dx is a cyst, however the gas collection would not be present

Right Pleural Effusion

Radiographic Findings Right Pleural Effusion: Low density signal. Differential dx is pleural thickening, however the density would be greater Right Perirectal Abscess: Low density signal suggesting fluid (pus) with small black bubbles suggesting gas collection. Differential dx is a cyst, however the gas collection would not be present

Right Perirectal Abscess

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

References Novelline, Robert. Squire’s Fundamentals of Radiology 5 th Ed CarecastPACS

Air and Fluid on Computed Tomography Tinika Montgomery University of Virginia School of Medicine February 24, 2006