71-year-old male admitted with sepsis and acute cholangitis. CT abdomen/pelvis with contrast to evaluate for source control opportunities and for occult intra-abdominal abscess.

None available.

Axial CT images of the abdomen and pelvis were obtained following intravenous administration of 100 mL Omnipaque 350. Multiplanar reformations were performed.

A solitary 8 mm solid pulmonary nodule is present in the medial right lower lobe (image 14, series 3). Borders are smooth. No additional pulmonary nodules. Small bilateral pleural effusions, right greater than left.

A 1.4 cm hypodensity is present in segment VII, too small to fully characterize on this study. Otherwise normal hepatic parenchyma. No focal mass. The intrahepatic biliary system is mildly dilated (CBD 8 mm), consistent with the patient's known choledocholithiasis. A 4 mm filling defect is present in the distal common bile duct.

Mild gallbladder wall edema with pericholecystic fluid. No frank perforation.

Mild peripancreatic stranding without ductal dilatation or focal lesion. Findings may reflect early inflammatory change versus passive congestion.

Normal in size. No focal lesion.

A 1.8 cm well-circumscribed lesion is present in the right adrenal gland with attenuation of approximately 15 HU, most likely representing a lipid-poor adenoma. Dedicated adrenal washout protocol would be confirmatory if clinically indicated. The left adrenal is unremarkable.

Both kidneys enhance symmetrically. A 1.2 cm simple cyst arises from the upper pole of the left kidney (Bosniak 1). No hydronephrosis.

Nondistended loops of small and large bowel. No pneumatosis or free air.

Atherosclerotic calcification of the abdominal aorta without aneurysm.

Multilevel degenerative change of the lumbar spine.

Unremarkable.

1. Findings compatible with acute cholangitis and a 4 mm distal common bile duct stone. Mild peripancreatic inflammation may reflect early gallstone pancreatitis versus passive change. No drainable collection. 2. 8 mm solid pulmonary nodule in the right lower lobe. Recommend follow-up per Fleischner Society guidelines (dedicated chest CT at 6-12 months given intermediate risk). 3. 1.4 cm hepatic hypodensity, indeterminate. Recommend dedicated abdominal MRI or contrast-enhanced ultrasound for further characterization. 4. 1.8 cm right adrenal lesion, most likely adenoma. Dedicated adrenal protocol CT can confirm if clinically warranted. 5. Additional incidental findings, no follow-up required: simple left renal cyst, multilevel lumbar degenerative change.