A seventy-six year-old man presented with a fever and the sudden onset of abdominal pain. He was tachycardic and hypotensive, thought not terribly so. His abdominal exam was notable for lower abdominal tenderness which did not lateralize; there was guarding present but no rebound tenderness, with an absence of bowel sounds. Multiple trauma patients were occupying the CT scanner and would be expected to do so for the foreseeable future. The surgeon on call was contacted and was reluctant to come see the patient without a CT scan. What finding is visible on the above plain film of the abdomen that might convince him to expedite his evaluation of the patient?
Please put your answers in the comments. First correct answer wins a genuine karmic invisishirt! Scanman and other radiologists are excluded from the competition, but may email me directly to establish their superiority. Just for the record, I did pick this finding up myself. (and as they say, if the ER doc can see it...)
07 January 2009
Posted by shadowfax at 5:38 AM