What is the cause of the patients symptoms?
Acute diverticulitis with abscess formation.
Look at the bladder; what do you see? What local complication could result in this patient if the infection remained untreated?
The bladder wall is thickened adjacent to the abscess and inflamed sigmoid. At this stage there is no evidence of luminal gas to suggest an established colovesical fistula, although this may well occur if treatment is delayed or unsuccessful.
What is the difference between diverticulosis and diverticulitis?
Diverticulosis refers to the presence of multiple diverticula. It is quite distinct from diverticulitis which describes inflammation and infection of one or multiple diverticula.
Name 4 incidental findings on this scan unrelated to the presenting complaint.
1) the aorta is aneurysmal with extensive irregular mural thrombus and extensive vascular calcification seen along the entire arterial tree. The right common femoral artery is also aneurysmal with evidence of previous intervention in the region; 2) renal cysts; 3) splenunculus; 4) extensive calcified pleural plaques are also noted, presumably representing prior asbestos exposure.
A 4 cm diameter rounded collection of fluid superiorly adjacent to the sigmoid colon which contains many diverticulae and is thick walled. It is in close proximity to the bladder wall, which also appears thickened. No gas can be seen in the bladder lumen to suggest a colovesical fistula.
In addition the aorta is aneurysmal with extensive irregular mural thrombus and extensive vascular calcification seen along the entire arterial tree. The right common femoral artery is also aneurysmal with evidence of previous intervention in the region.
Incidental renal cysts and splenunculus noted. Extensive calcified pleural plaques are also noted, presumably representing prior asbestos exposure.