A 60 year old man presents with suprapubic pain of 3 days duration. He describes a ‘pelvic ache’ on urination; there is suprapubic tenderness and possible guarding on examination; and leukocytes in the urine.
You are considering just treating as a urinary tract infection but the degree of tenderness makes you take a look with ultrasound.
Describe and interpret these scans
Image 1: Oblique suprapubic image just to the left of midline at the site of maximal tenderness.
A segment of sigmoid colon with thickened wall is seen. Off the deep surface arises a large diverticulum with a 15mm diameter. It contains some air and has echogenic surrounding mesenteric fat consistent with inflammation. Transducer pressure was maximal at this site.
Image 2: Addition of Power Doppler.
Increased flow is seen in the wall of the diverticulum and surrounding mesenteric fat consistent with inflammatory hyperaemia.
The search for suspected diverticulitis:
- Scan the site of maximal tenderness considering all potential differentials
- Scan the descending and sigmoid colon in transverse section beginning about half way down the left side