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CT Abd Colonic Wall Thickening

Findings: The patient is status post hemicolectomy with distal reanastomosis. 1. There is focal circumferential colonic wall thickening and luminal narrowing of the mid descending colon with associated pericolonic fat stranding. 2. There is a small focal area of luminal narrowing in the proximal rectum, which may represent collapsed bowel versus a mass lesion. Recommend further evaluation with direct visualization versus CT colography. 3. There is focal circumferential colonic wall thickening and luminal narrowing just below the hepatic flexure with minimal pericolonic fat stranding. Several enlarged mesenteric lymph nodes are noted. There are scattered diverticula throughout the colon. Several calcified uterine fibroids are again noted. Otherwise, the pelvic organs are unremarkable. There is no lymphadenopathy. Atherosclerotic vascular calcifications are seen throughout the abdominal aorta and its major branches. The aorta is normal in caliber. Scarring is seen in the right lower lung which is likely postsurgical given the absence of a portion of the rib. This is unchanged from comparison CT. The visualized heart and great vessels are unremarkable. There are degenerative changes seen throughout the osseous structures with the T11 compression fracture again visualized, not significantly changed from 2011. There is bilateral L5-S1 spondylolisthesis which results in grade 1 anterolisthesis. IMPRESSION: 1. Nonspecific focal circumferential descending colonic wall thickening with associated pericolonic fat stranding. Differential would include infectious or inflammatory processes, however neoplasm would be the diagnosis of exclusion. Recommend correlation with colonoscopy history and direct visualization and tissue sampling as warranted. 2. Multiple colonic diverticula without evidence of diverticulitis. -------------------------------- Findings: The visualized lungs demonstrate dependent atelectasis. There is no no mass, consolidation or pleural effusion. The heart and great vessels are normal. Calcification is noted at the takeoff of the celiac trunk without evidence of significant stenosis. SMA and IMA appear normal in caliber and contrast enhancement. A large hiatal hernia is again noted. Diffuse fatty infiltration of the liver is demonstrated without focal abnormality. There is fluid density around the collapsed gallbladder with normally appearing wall. The pancreas is mildly atrophic. The spleen demonstrate small amount of perisplenic fluid but is otherwise unremarkable. Bilateral adrenal glands and kidneys are unremarkable. A mesenteric fat infiltration with prominent vasa recta is noted within the right lower quadrant around the terminal ileum and cecum. There is mild cecal wall thickening. Enteric contrast extends to the rectum. The appendix is well-visualized without evidence of inflammation, although the mesentery adjacent to the appendix is inflamed. Colonic diverticulosis without evidence of diverticulitis is noted. There is no evidence of free fluid or free air in the peritoneal cavity. There is no lymphadenopathy. The bladder is normal. Severe degenerative disease of the lumbosacral spine is noted. IMPRESSION: 1. Terminal ileum, pericecal and ascending colon changes as described above may represent inflammatory, infectious or ischemic etiology. There is no evidence of mesenteric vascular abnormality on this exam, although bolus timing is not optimal for angiographic evaluation. Correlate with clinical and laboratory values and consider followup imaging as clinically dictated. 2. Unchanged hepato-steatosis. 3. Unchanged large hiatal hernia. 4. Diverticulosis without evidence of diverticulitis. 5. Pericholecystic fluid, likely related to volume resuscitation.