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Age: 77

Sex: Male

Indication: Epigastric pain

Save ("V")

Case #24


Findings

  • Lower chest
    • Mild centrilobular emphysema
    • 4 mm nodule in the lingula
    • Left lower lobe calcified granulomas
    • Moderate coronary artery calcification
  • Abdomen/Pelvis
    • Dilation of multiple loops of proximal and mid small bowel with transition point in the mid abdomen adjacent to a partially calcified 3 x 2 cm soft tissue mass in the small bowel mesentery with surrounding desmoplastic reaction
    • Diffuse stranding in the small bowel mesentery with interloop fluid and multiple enlarged lymph nodes
    • Multiple enlarged retroperitoneal lymph nodes with an index left para-aortic node measuring 2.6 cm in short axis
    • Small volume abdominopelvic ascites
    • Hepatomegaly with nodular surface contour of the anterior right hepatic lobe
    • Multiple hypodense hepatic lesions with ill-defined margins
    • Small amount of layering high density material in the gallbladder which could represent sludge or small stones
    • Calcified granulomas in the spleen
    • Mild diffuse pancreatic atrophy
    • Punctate nonobstructing calculus in the upper pole of the right kidney
    • Subcentimeter hypodense lesions in the left kidney are too small to characterize
    • Small volume free intraperitoneal fluid layering in the pelvis
    • Atherosclerotic calcification of the abdominal aorta and branch vessels without aneurysm
  • MSK
    • No acute osseous findings
    • Mild degenerative changes of the spine
    • Mild body wall edema


Diagnosis

  • Small bowel obstruction due to intestinal carcinoid

Sample Report

Findings concerning for high-grade small bowel obstruction with transition point in the mid abdomen adjacent to a mesenteric mass. The imaging characteristics of this mass favor carcinoid tumor.

Likely metastatic lymphadenopathy in the small bowel mesentery and retroperitoneum and metastatic liver lesions. Consider DOTATATE-PET for further evaluation.

Nonspecific 4 mm pulmonary nodule in the lingula. Recommend attention on followup imaging.

Mildly nodular surface contour along the anterior right hepatic lobe. Recommend correlation with laboratory evidence of cirrhosis.


Discussion

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Images

Partially calcified mass in the small bowel mesentery with surrounding desmoplastic reaction, which is a classic imaging appearance for carcinoid tumor.



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