34 year old male presents with suprapubic discomfort, tachycardia, hypertension and a ruddy complexion. Bladder scan determined 750mL of urine within the bladder and distal cause for urinary obstruction was sought.

Radiological examination is presented below. Any thoughts?

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

It is another busy night in ED. The ‘Bat-Phone’ rings, gently pricking the ear to attention in anticipation of the next code…

We are bringing in a 60 year old lady with profuse diaphoresis, hypotensive with a systolic of 70 and altered conscious state…

Initial examination confirms an unwell lady, drained of colour, drenched in sweat taking short shallow breaths. Following application of oxygen, comprehensive non-invasive monitoring, IV access and analgesia you decide to perform a rapid bedside abdominal USS (even though you are by no means an expert in wielding the mighty sono sword)…but it is late, the really clever sonoboys are all tucked up in bed…so it’s all up to you – SonoMan^®

Through the vagaries of shadows that are beholden to the sonographic snowland you think you see a cave-like compressible opening around 5-6cm in diameter…but lets face it – the howling blizzard you just demonstrated on the sono-machine-thing hasn’t really helped you refine your differential diagnosis

So you send your patient to the ‘Donut of Death’ for a dose of real radiation

Now what Doc?

Abdominal CT scan

Additional images (for @scanman)

Acalculous Cholecystitis

Acalculous Cholecystitis

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

Life in the Fast Lane Medical Blog - Emergency Medicine education blog

In stark contrast to Radiological oddity #1 – this actually involves pathology

Life in the Fast Lane Medical Blog - Emergency Medicine education blog