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Air and Fluid on
Computed Tomography
Tinika Montgomery
University of Virginia School of Medicine
February 24, 2006
History
62 yo immunosuppressed M with h/o EtOH cirrhosis, three
months s/p orthotopic liver transplant, presented with
N/V, intermittent colicky abdominal pain that began two
days PTA. Patient admitted flatus and last BM three days
PTA.
On admission, vital signs were WNL and the exam was
unremarkable. CXR, AXR, EKG and labs obtained were
unremarkable. An NGT was placed yielding 200cc of
fluid.
Patient became obstipated with abdominal distention
during hospitalization, and CT of the abdomen and pelvis
with oral contrast were ordered.
Radiographic Findings
Right Pleural Effusion:
Low density signal. Differential dx is pleural
thickening, however the density would be
greater
Right Perirectal Abscess:
Low density signal suggesting fluid (pus) with a
small black bubble suggesting a gas collection.
Differential dx is a cyst, however the gas
collection would not be present
Right Pleural Effusion
Radiographic Findings
Right Pleural Effusion:
Low density signal. Differential dx is pleural
thickening, however the density would be
greater
Right Perirectal Abscess:
Low density signal suggesting fluid (pus) with
small black bubbles suggesting gas collection.
Differential dx is a cyst, however the gas
collection would not be present
Right Perirectal Abscess
Disposition
Patient discharged to home with diagnosis of
nausea and vomiting on home medications,
including immunosuppressants. Hospital course
involved medical management without further
surgical intervention or radiographic study.
References
Novelline, Robert. Squire’s Fundamentals of
Radiology 5th Ed. 1997.
Carecast
PACS
Air and Fluid on
Computed Tomography
Tinika Montgomery
University of Virginia School of Medicine
February 24, 2006