2007 Radiology Exam - Abdomen Case 2

“Lily”

• Sg: 10 month “MiKi” (Pronounced Me-Key) Fe
• Hx: straining, bred -- but unknown due date
• Rads: 2 views abdomen

See images below. Click to enlarge.

Candidates received points for:

• Abnormal Radiographic Findings: gas in a rounded shape, surrounding very large fetus with head wedged in pelvic canal; fetal skull measuring nearly same size as pelvic diameter; mottled gas in fetal abdomen; possible free air in maternal abdomen; collapse of fetal skull bones
• Radiographic Diagnosis: fetal/maternal disproportion and dystocia; dead fetus; gas in the uterus and in the fetus and possibly free in the maternal abdomen suggesting uterine rupture
• Points were deducted if abdominal ultrasound was recommended to evaluate for fetal vitality, since the fetus is surrounded by gas and there are multiple radiographic signs of fetal demise

Outcome:

• Surgery: Ruptured uterus with free air and fluid in abdomen; dead, mature single fetus; communication between colon and uterus with no regional adhesions – suspect congenital?