MEDICAL IMAGING QUIZ CASE 33 Medical Imaging Quiz-Case 34

P Galani, A Koundouraki, L Kosma, K Galanis, G Dimitrakopoulou, S Lafoyianni
unpublished
An 89-year-old male was admitted to the emergency department with a constant chest pain radiating to the back, with a 24 hours' duration. The patient had a history of hypertension, hypothyroidism, angina and partial colectomy (polyps exertion). On his first day in the hospital, the patient presented fever with shaking chills. Laboratory findings included ECG with no signs of ischemia, negative troponin test, SGOT 120 IU/L, SGPT 246 IU/L, LDH 474 IU/L, Na 131 mEq/L and Ca 7.7 mg/dL. The patient
more » ... tarted antibiotic treatment with amoxicillin and clavulanic acid, but did not respond to the therapy. An abdominal and pelvic CT showed a low density lesion (4.5×5×8 cm) above the left kidney with displacement of splenic vessels (fig. 1) and another low density lesion (5.8×3.2×10.4 cm) with calcifications on the wall along the rectus abdominis muscle (fig. 2), findings indicating abscesses formations considering the clinical condition of the patient. Blood cultures were taken and a strain of Cedecea spp was isolated as the predominant organism. The cardioultrasound showed no signs of infection. The organism was susceptible to cephalosporins (b, c, d), aminoglycocides, quinolone and penems. The antibiotics were changed to cefuroxime intravenously, and the patient recovered and was discharged from the hospital on day 20. Figure 1. CT scan showing a low density lesion above the left kidney with displacement of splenic vessels. Figure 2. An abscess with calcifications on the wall along the rectus abdominis muscle shown in the abdominal computed tomography.
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