Poor renal function precluded the use of IV contrast.
The stomach appears entirely intrathoracic. There is gas and fluid surrounding this structure consistent with perforation and / or volvulus. Displacement of the mediastinum anteriorly and to the left with significant mass effect on the left atrium and to a lesser degree the right atrium. Small pericardial and pleural effusions. Minor dependant atelectasis.
Large volume intraperitoneal free gas. Moderate volume free fluid.
Within the limitations of a non-contrast study the liver, spleen, pancreas, right kidney and adrenal gland appear normal. Cholelithiasis. Simple cyst within the left kidney. Possible nodule associated with the left adrenal gland. Colonic diverticulosis without evidence of complication. Minor faecal loading. No evidence of bowel obstruction.
Heavily calcified vasculature.
- The findings are most consistent with perforation of an intrathoracic stomach and / or gastric volvulus.
- Surrounding free fluid and gas contributes to mediastinal displacement anteriorly into the left. Significant mass effect on the left atrium and to a lesser degree the right atrium.
- Large volume intraperitoneal free gas and moderate volume free fluid.
Urgent surgical review is recommended.