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CT Abd TOA

Findings: A normal appearing contrast-filled appendix is seen in the right lower quadrant. There are bilateral elongate tubular structures within the adnexa. There is a small amount of fluid in the cul-de-sac. The liver, pancreas, spleen, adrenal glands, kidneys and bladder are normal. The visualized skeleton is unremarkable. Conclusion: 1. No evidence of acute appendicitis. 2. Elongate fluid-filled tubular structures within the adnexa may represent hydrosalpinx versus less likely pyosalpinx. Cannot exclude tubo-ovarian abscess. Recommend pelvic ultrasound. 3. Small amount of fluid in the cul-de-sac. -------------------------------- Findings: Lung bases are clear. Visualized pericardium and mediastinum are unremarkable. The spleen, pancreas, adrenal glands, and kidneys are normal in appearance. There is a 4 mm round low-attenuation lesion within the right hepatic lobe (imaged 39 of sequence 3). This is too small to characterize by CT, but may represent a small hepatic cyst. The liver is otherwise unremarkable in appearance. There is no intrahepatic or extrahepatic biliary dilatation. The gallbladder is within normal limits for CT technique. There is no hydronephrosis or perinephric fluid collections. Oral contrast is seen to transit through to the mid descending colon. There are no dilated loops of bowel or evidence for obstruction. The appendix is identified and demonstrates a normal caliber. The proximal portion of the appendix fills with contrast. Urinary bladder is well distended and is without bladder wall thickening or irregularity. IUD is noted within the uterus. Uterus is normal in appearance for CT technique. There is a multiloculated fluid collection demonstrating rim enhancement within the pelvic cul-de-sac. The collection measures approximately 6.9 cm in AP dimension x 5.3 cm in transverse dimension by 4.6 cm in cranial caudal dimension. There are surrounding inflammatory changes. Adjacent to the loculated fluid collection in the left hemipelvis is a 2.4 x 2.9 x 2.4 cm round dense mass which appears to be separate from the bowel. This may be associated with the left ovary. There is no free intraperitoneal air identified within the abdomen or pelvis. Osseous structures are unremarkable. Impression: 1. Loculated rim-enhancing fluid collection with a pelvic cul-de-sac most consistent with a pelvic abscess. Given additional history of PID, this likely represents a tuboovarian abscess. Adjacent 2.9 cm round dense mass is of uncertain etiology but may be associated with the ovary. Consider followup pelvic ultrasound as clinically indicated. 2. Normal appearance of the appendix.