Ct Of The Abdomen And Pelvis With Contrast By Kanika Mosley

Ct Of The Abdomen And Pelvis With Contrastby Kanika Mosley

CT of the Abdomen and Pelvis with Contrast by Kanika Mosley 1 Patient History Male, Age 51 Weight: 225 pounds Diagnosis: Left lower abdominal pain History of hepatic steatosis (non-alcoholic fatty liver disease) IV Contrast allergy: Negative Diabetic 2 Patient History Contrast Screening Form indicated use of Metformin Labs results within 30 days Creatinine: 0.9; within normal range for Adult male of 0.70 – 1.20 mg/dL eGFR: 60 mL/min/1.73m2; within normal range of >60 mL

Patient Preparation Patient was advised of procedure and provided written informed consent for intravenous contrast. Patient fasted for 2 to 6 hours before exam. Oral Contrast provided 30 minutes prior to exam Contrast Agents 138 mL of Isovue- mL of saline flush

Patient Preparation Venipuncture 22 gauge needle Gauze Tourniquet Bioclusive IV access: Right Accessory Cephalic Vein

Patient Positioning Supine Arms raised above head Patient instructed to suspend on respiration (breath hold)

Scan Parameters DFOV (Display Field of View): 32 Slice thickness: 1.25 mm/1.25 mm 120 kVp; 288, mA Delayed Scan Portal Venous Phase 60 second delay

Scan Parameters SFOV: Large body WW: 400 WL: 40 Noise Index: 13.

Images Scouts AP Lateral 9 Images Smart Prep ROI: Liver ROI

Abdomen Axial Images 1st Slice WW: 400 WL: Abdomen Axial Images Slice 22 WW: 400 WL: 40 Liver Stomach Spleen Descending aorta Portal Venous Phase (60 seconds) for optimal visualization of the abdomen and pelvis.

Abdomen Axial Images Slice 34 WW: 400 WL: 40 Right Kidney Left Kidney Superior mesenteric vein Superior mesenteric artery The kidneys are well visualized. The patient has been instructed to drink plenty of water to flush contrast out kidneys.

Pelvis Axial Images Slice 58 WW: 400 WL: 40 Cecum Sacrumm Ilium Ileum Jejunum Psoas muscle Erector spinae muscle There is a significant amount of gas in the colon.

Pelvis Axial Images Slice 82 WW: 400 WL: Tolerance Patient was very tolerable of examination. Patient was monitored for a few minutes after exam for reaction to contrast agent.

Paper For Above instruction

The computed tomography (CT) scan of the abdomen and pelvis with contrast performed on a 51-year-old male patient provides critical insights into the patient's abdominal health, specifically targeting the causes of left lower abdominal pain and evaluating existing hepatic conditions. This non-invasive imaging modality is instrumental in diagnosing gastrointestinal, hepatic, vascular, and other intra-abdominal pathologies, especially when guided by detailed patient history and clinical presentation.

The patient’s history indicates hepatic steatosis (non-alcoholic fatty liver disease), a condition characterized by excessive fat accumulation in liver cells, known to be associated with metabolic syndromes such as obesity, insulin resistance, and dyslipidemia. The recent improvement noted in hepatic steatosis suggests prior management efforts, potentially including lifestyle modifications or medical therapy. The patient also reports left lower abdominal pain, which warrants detailed imaging to assess for potential sources such as diverticulitis, bowel obstructions, or other intra-abdominal pathology.

The examination utilized IV contrast (Isovue) to enhance visualization of vascular structures and organ parenchyma, performed after confirming the patient's allergy history was negative for contrast agents. The patient’s renal function, measured via serum creatinine (0.9 mg/dL) and estimated glomerular filtration rate (eGFR of 60 mL/min/1.73m²), was within acceptable limits for contrast use, with proper hydration instructions provided to facilitate contrast clearance from the kidneys.

Preparation for the scan included fasting, intravenous access via the right accessory cephalic vein, and administration of oral contrast 30 minutes prior. The patient was positioned supine with arms raised overhead, with instructions to suspend breathing during critical imaging phases to reduce motion artifacts. The scan parameters were carefully optimized: slice thickness of 1.25 mm, display field of view (DFOV) of 32, and portal venous phase delayed imaging at 60 seconds post-contrast administration to optimize visualization of abdominal and pelvic vasculature and organs.

The images acquired included scout views, axial images of the abdomen and pelvis, and detailed visualization of multiple structures. Notable findings include the presence of colonic diverticulosis, characterized by small, bulging sacs of the intestinal lining, which become inflamed but were not currently obstructive. This condition may account for some of the patient's abdominal discomfort, particularly in the left lower quadrant.

The liver, stomach, spleen, and vessels such as the descending aorta, superior mesenteric artery, and veins were well visualized, with the area of the liver showing improvement consistent with prior reports of fatty liver reduction. The kidneys appeared normal, with no signs of obstruction, significant lesions, or vascular abnormalities. The patient's instruction to hydrate well is crucial in supporting renal clearance of contrast and preventing nephrotoxicity, a particularly important consideration given the marginal eGFR.

The pelvis images further revealed gas within the colon, typical of routine bowel gas distribution but also confirming the absence of bowel obstruction or perforation. The anatomical details of the cecum, ileum, jejunum, and surrounding muscles (psoas and erector spinae) were clearly visualized, contributing to comprehensive assessment.

Post-examination, the patient tolerated the procedure well with no immediate adverse reactions observed. The clinician recommended resuming Metformin after 48 hours, emphasizing the importance of hydration to aid contrast elimination. Continued adherence to ALARA (As Low As Reasonably Achievable) principles and the "Image Gently" pledge guide safe imaging practices, minimizing radiation exposure and avoiding unnecessary procedures.

Overall, the CT scan results support a diagnosis of colonic diverticulosis without evidence of acute bowel obstruction or perforation. The improvement observed in hepatic steatosis indicates effective management. These detailed findings assist clinicians in tailoring appropriate treatment plans, including management of diverticular disease and ongoing hepatic monitoring.

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