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Case # 26

 

History
38 y/o F with abdominal pain

PMHx:

HIV CD4 80 h/o PCP

s/p TAH cervical ca age 24

h/o IVDU in past

experiencing sharp, periumbilical pains over the past 3 days, lasting 30 seconds, but occurring every 10 minutes or so. Developed nausea, vomiting, dry heaves. Also developed small liquid stools. No fever chill or night sweats

Physical Exam
Temp 97.4 BP 107/76 HR70 RR14

Abd: bowel sounds present, decreased. soft but right lower quadrant tenderness. No rebound. Stool is brown, guaiac negative

Laboratory
WBC 3.0 (67P,24L,8M,1E)

Hct 44

Electrolytes and liver function tests are unrenarkable

Radiology
KUB - suggestive of ileus, or early small bowel obstruction

Patient undergoes a CT scan to evaluated appendicitis (CT used frequently to evaluate appendicits at our institution - patient gets rectal contrast ,special protocol)

The CT findings:

A radiologist unfamiliar with the case made the diagnosis from across the room basd on this ct image. What is the diagnosis?