Journal of radiology case reports
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The presence of superficial bruising, no abnormal signs on abdominal examination and a negative FAST scan of the abdomen may not be enough to rule out intra-abdominal pathology. We report on the usefulness of CT in diagnosing a post-traumatic abdominal wall hernia.
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We report the case of a 23 year-old obese female, with previously diagnosed situs inversus below the diaphragm, who presented with severe left upper quadrant abdominal pain. The patient was believed to have a surgical indication, possibly appendicitis or diverticulitis, and had an emergent abdominal Computed Tomography (CT) scan. The CT was interpreted as epiploic appendagitis with no signs of appendicitis. ⋯ This case was complicated by the fact that the patient had situs inversus below the diaphragm, which made it difficult to relate her localized abdominal pain to the correct anatomic area. The diagnosis allowed the patient to avoid invasive surgery and instead opt for conservative medical management. The utilization of radiologic imaging is of utmost importance in diagnosing this condition, which has characteristic findings on CT, US, and MR, all of which is discussed in this article.
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A 62 year old woman status post radical nephroureterectomy for high grade urothelial carcinoma was found on CT to have a 1 cm retroperitoneal nodule in the nephrectomy bed. The nodule's differential diagnosis included recurrent urothelial carcinoma versus relocation of the patient's splenule seen on earlier CT imaging. We report using SPECT/CT with Tc-99m labeled denatured red blood cells to definitively diagnose the nodule as a relocated splenule.