Satisfaction of search
Young female presents with abdominal pain. Known issues with alcohol. Routine lab tests show elevated LFT’s, with a markedly elevated bilirubin. Routine CT scan of the abdomen ordered from the ER shows hepatic steatosis (surprise!) and ascites. Spectral CT images show a very heterogeneous liver on iodine map and low KeV images, consistent with steatohepatitis. This is important, as it can be very painful, and the heterogeneous enhancement differentiates it from a simple fatty liver. The heterogeneous enhancement can be best appreciated on dynamic MR, but on a routine portal venous CT, you need spectral analysis to appreciate it.
But there is more…
There is a filling defect in the cecum. This shows iodine uptake (have to be careful, as stool may show artifactual iodine uptake), and seems to have a stalk. A cecal mass was suspected, and confirmed on colonoscopy, where histology showed a tubular adenoma.
Patient did well on follow up after cessation of ethanol intake. This case illustrates the importance of something I learned on my first day in radiology residency: satisfaction of search. You got to keep looking, spectral CT will help you find!