CT - Scheduled outpatient abdominal CT
Axial C+ arterial phase
Coronal C+ arterial phase
Sagittal C+ arterial phase
Axial C+ portal venous phase
Coronal C+ portal venous phase
Sagittal C+ portal venous phase
The extent of the abnormalities present in this exam is dangerously overwhelming, but the critical finding necessitating immediate attention is present in the first few slices of the axial arterial phase scan:
- multiple subsegmental emboli are partially visible in right lower lobe pulmonary arteries
- in the venous phase partially occlusive bilateral CFV deep venous thromboses are visualized
Fortunately although this was an outpatient, non-emergent exam, it was read within minutes, before the patient left the clinic , who was therefore immediately brought back for a chest CT angiography to evaluate the extent of the PE (see next exam).
Other major findings:
A hypodense mass is visible in the body and tail of pancreas, with distal pancreatic duct dilation. The splenic artery passes through it, and shows marked narrowing and wall irregularity. The splenic vein is obstructed, as a consequence the umbilical vein has recanalized.
Large parts of the spleen show geographic hypoenhancement, in line with splenic infarction caused by the pancreatic mass.
Multiple hypodense solid lesions showing early washout are visible in the enlarged liver, characteristic of liver metastases.
Locoregional lymphadenomegaly. Smaller hypoenhancing masses in the left adrenal. Inhomogenous soft tissue mass in the ventral lower mediastinum.