Case discussion
01Clinical context
A patient presented with left lower quadrant abdominal pain. Ultrasound was performed to evaluate for acute intra-abdominal pathology, focusing on the sigmoid colon and adjacent tissues.
02Key imaging findings
Ultrasound showed multiple diverticula in the sigmoid colon with increased echogenicity of the surrounding pericolic fat, indicating localized inflammation consistent with acute diverticulitis. Minimal free fluid was noted in the pelvis without evidence of abscess or drainable collection. Multiple hepatic cystic lesions were seen, the largest measuring 3.2 × 2.7 cm, with associated intrahepatic and mild extrahepatic biliary ductal dilatation. Both kidneys, spleen, and bladder appeared normal.
03Diagnostic reasoning
The diagnosis was based on targeted transabdominal ultrasound of the left lower quadrant, focusing on the sigmoid colon. Identification of multiple diverticula with surrounding echogenic fat indicated localized inflammation. Absence of organized fluid collections or abscesses was noted, but ultrasound's limited sensitivity for deeper complications was acknowledged. Hepatic cystic lesions and biliary dilatation were noted incidentally, with recommendation for correlation with prior CT/MRI for further characterization.
04Questions for clinical practice
What is the role of ultrasound in diagnosing acute sigmoid diverticulitis?
Ultrasound can detect diverticula and pericolic inflammatory changes but may miss deeper complications like abscesses or perforations.
When should further imaging be considered?
If clinical suspicion remains high or complications are suspected, contrast-enhanced CT is recommended for detailed evaluation.
How should hepatic cystic lesions and biliary dilatation be managed?
Correlation with prior CT/MRI and liver function tests is essential; MRCP may be considered if biliary dilatation is unexplained or progressive.
What clinical follow-up is advised?
Prompt clinical evaluation and monitoring by the treating physician and gastroenterology service are important for management and surveillance.
05Teaching point
Ultrasound can identify acute sigmoid diverticulitis by demonstrating diverticula and inflammatory changes in pericolic fat, but it has limitations in detecting complications such as abscesses or perforations. Correlation with clinical findings and further imaging, such as contrast-enhanced CT, is essential for comprehensive assessment. Hepatic cystic lesions and biliary dilatation require prior cross-sectional imaging for characterization and follow-up.
Shown for education. De-identified — no identifiable patient data. A radiology report is a specialist opinion and must be read with the full clinical context by the treating physician.