Traumatic bowel injury
Motor vehicle collision. Driver.
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Pneumoperitoneum and moderate amount of intraperitoneal free fluid (water density) is in keeping with bowel perforation. There is a particularly abnormal appearing loop of small bowel that is transversely oriented across the central abdomen. This appears moderately distended, measuring 2.5 cm in maximum dimension and has internal increased density suggestive of blood. More diffuse small bowel wall thickening in the setting of hypovolemia (collapsed IVC) suggests "shock bowel". Diffuse mesenteric stranding in keeping with mesenteric traumatic injury. Bulky left adrenal gland suspicious of hemorrhage.
Right pleural effusion. Emphysematous changes and calcified pleural plaques noted. Hiatus hernia. Moderate to severe coronary artery calcification.
Non united right L1 transverse process, a normal variation.