Clinical Images

Abdominal Distension on Abdominal Radiograph

Author: Cecil A. Rambarat, M.D. 

A 36-year-old female with a history of intravenous drug abuse, post-traumatic stress disorder, military sexual trauma and major depressive disorder presented with chief complaints of shortness of breath and right foot pain. The patient became acutely hypoxic in the emergency department requiring emergent intubation. Physical examination was remarkable for a new systolic cardiac murmur, splinter hemorrhages, an ulcerative necrotic appearing lesion on the dorsum of the right foot, absent pedal pulses and decreased spontaneous right sided movements. Computed tomography scan of the patient’s brain revealed a left medial cerebral artery infarct.  A chest x-ray revealed mild pulmonary edema, and an echocardiogram revealed mitral and aortic valve vegetations complicated by severe aortic insufficiency.  Laboratory testing revealed the sequelae of acute renal and hepatic failure, and blood cultures were positive for Staphylococcus aureus. Despite antibiotics, she was maintained on a mechanical ventilator due to poor improvement in mentation.  Her hospital course was acutely complicated by septic shock requiring inotropic medications, a worsening anion gap metabolic acidosis and increasing abdominal distension for which an emergent abdominal radiograph was obtained.

MCQ 1: Which of the following is the most common cause of hepatic portal venous gas (HVPG)?

A. Small bowel obstruction

B. Intra-abdominal abscess

C. Ulcerative colitis

D. Necrotic bowel

E. Gastric ulcer

Click here for answer

References:

1. Paul R. Liebman, Michael T. Patten, Jonah Manny, John R. Benfield. 1978. "Hepatic-Portal Venous Gas in Adults: Etiology, Pathophysiology and Clinical Significance." Annals of Surgery 281-287.

2. Michael J. Smerud, C. Daniel Johnson, David H. Stephens. 1990. "Diagnosis of Bowel Infarction: A Comparison of Plain Films and CT Scans in 23 Cases." American Journal of Roentgenology.

Author Information:

Dr. Cecil A. Rambarat was born in Bridgetown, Barbados. He emigrated to North Carolina where he completed undergraduate studies in Biochemistry, and medical school at the University of North Carolina at Chapel Hill. Dr. Rambarat is currently completing his Internal Medicine Residency at UF Health Shands Hospital. His interest in imaging stems from his father, who is a retired Radiologist.