A Day at the Office - Renal Infarct CT Scan

I couldn't resist posting this unusual scan I performed recently. It happens to be a friend of mine but identity isn't important. What started out as right flank pain became so severe that "Bob" came to my Emergency Room.

A routine CT Abdomen&Pelvis and Renal Ultrasound showed nothing other than a right renal cyst on the inferior pole. The patient was discharged home only to return later that night (on my shift) with increased pain. Evaluation of a second set of bloodwork showed a marked increase in white blood cells so the ER Physician decided to order a second CT Abdomen&Pelvis but with IV and PO contrast dye this time.

The image attached to this blog post shows a fully enhanced left kidney (its on the right side of the screen) and a poorly enhanced right kidney. The right kidney appears to only be receiving contrast dye in the upper and lower poles. The middle pole is almost non-existent.

With these images, the medical team was able to discern a renal infart or possible discection was in play and "Bob" was taken to the Cath Lab for stenting. He is doing much better now, one week later, and is schedule for more follow up testing to check perfusion rates.

Daddy...my tummy hurts! Acute Appendicitis

Another unusual CT Scan today (for me anyway). A 10 year old boy came in with his father complaining of RLQ pain (right lower quadrant). This can be a sign of problems with the appendix and normal Emergency Room protocol demands a CT Scan of the Abdomen&Pelvis with Oral and IV contrast.

I've attached the axial (cross-sectional) image of his pelvis. The little worm or snail looking thing (as my wife calls it) in the upper left corner is his highly enlarged appendix.

Little man was transferred out of our facility to a more appropriate children's facility where I'm sure he had it removed by morning.

My ER Physician that evening was also a surgeon and he stated that in all his years in surgery, he'd never seen an appendix look like that one.