Case of the Month: March, 2012

Submitted by Christine Ghatan, MD and Marcel Maya, MD .

History: 60 year old female presents to the emergency department with decreased p.o. intake, diarrhea, lethargy, and confusion. The prior month, she had been admitted for altered mental status and management of Clostridium difficile colitis. Her symptoms improved somewhat following a course of the appropriate antibiotics. Her diarrhea and weakness subsequently worsened over the past 6-7 days. Over the past 2-3 days, she had decreased p.o. intake, resulting in weakness, lethargy and confusion. On physical exam, her abdomen is soft, non-tender and moderately distended. Labs show she has a white blood cell count of 43.8, with 52% bands. Her urine analysis shows she has a urinary tract infection.

Question: : What is the most appropriate first imaging study to obtain, according to the American College of Radiology’s appropriateness criteria?

  1. Abdominal ultrasound.
  2. Abdominal radiograph.
  3. CT Abdomen and Pelvis with contrast.
  4. CT Abdomen and Pelvis without contrast.
  5. No imaging.
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