May 5, 2008

A 21 y/o man with right flank pain.

A 21 y/o man presented with right flank pain. Emergency Room physicians asked for CT scan of KUB system to evaluate renal and KUB stone.
The patient had lower abdominal pain, fever and microscopic hematuria.

Results: No stone in both kidneys, ureters or bladder is identified. We found inflammation and thickening of sigmoid colon. Divericulitis was concerned. Disporportion of fat stranding and thickening bowel wall are important findings to evaluate the origin of disease process. Less fat starnding , more likely that the the center of disease is in the bowel wall; infection, pseudomembranous colitis, ischemia, IBD. More fat stranding, more likely that the disease process is in the pericolic fat; diverticulitis. The patient has more pronounced sigmoid mesocolon stranding than thicken bowel wall. The other important differential diagnosis is the inflammatory sigmoid colon cancer. Once we found diverticulits, we need to look for complications; abscess formation, perforation and fistula.

Take a closer look. We will see fluid collection in the rectovesicle pouch which looked like leakage fluid than abscess due to lack of well defined wall, although early abscess formation cannot be excluded. A few air bubble is also seen in keeping with perforation or less likely an abscess.

Answer: Sigmoid diverticulits with perforation. No abscess formation.

Reference: Disproportionate Fat Stranding: A Helpful CT Sign in Patients with Acute Abdominal Pain. Radiographics. 2004. 24;703-715.

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