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CT scan shows a left parietal haemorrhage with an underlying mass which demonstrates some enhancement post contrast. There is surrounding vasogenic oedema and a small amount of midline shift.
Massive distension of bladder
The urinary catheter is visible within the bladder.
Of note is a gross bladder wall thickening on the left side (on CT this was measured as up to 2 cm) No significant pelvic lymphadenopathy visible. No bony destructive change seen.
CT pulmonary angiogram on bone windows shows a massive pulmonary embolism straddling right and left pulmonary arteries (saddle embolus). Even large emboli can be missed if the contrast in the main pulmonary arteries is very dense and the images are viewed on normal mediastinal windows. Altering the windows can help to increase visibility of thrombus.
There is almost complete occlusion
Pulmonary fibrosis ? Usual interstitial pneumonia
There is diffuse reticulo-nodular shadowing, which is most marked in the lower lower zones bilaterally. There is differential volume loss in the lower zones. There are reticular changes seen adjacent to the heart borders and subpleurally. Findings are suggestive pulmonary fibrosis. The radiographic appearances are most typical of Idiopathic Pulmonary fibrosis.
Bronchiolitis and Pneumothorax
Due to poor clinical picture a preliminary diagnosis of bronchiolitis was made.
X-ray was performed after admission showing a RIGHT pneumothorax of RIGHT upper lobe, with minimal compression of Middle and Lower lobes.
"Kidney shaped" gas bubble of distended caecum, with evidence of complete bowel obstruction due to evidence of little gas in rest of lower GI tract
Found in usual location to the left of mid-line
No fluid level visible
Large bowel obstruction or pseudoobstruction (no further CT scan done to distinguish)
Generalised gaseous distention of the large and small bowel. No gas in the rectum.
