Findings:
There is advanced atherosclerosis of the abdominal aorta. There is severe narrowing and occlusion of the origins of the celiac access and SMA. The IMA is patent and nonaneurysmal. There is collaterized flow in the branches of the SMA and celiac access. There are 2 right renal arteries and a single left renal artery – their origin is patent. There is extensive gas in the mesenteric vessels. There is also extensive pneumatosis involving the stomach and small bowel. There are scattered hematomas in the intra-abdominal wall likely reflecting medication injection sites.

There is bibasilar subsegmental atelectasis. There are also mild fibrotic changes with associated traction bronchiectasis. There is portal venous gas. The liver parenchyma is heterogeneous. There are peripheral hypodensities in the spleen which is concerning for an infarction in the current clinical setting. The left kidney is atrophic. There is expected positioning of a right nephroureteral stent extending form the right renal pelvis into the urinary bladder. There is a small amount of simple fluid in the pelvis.

Impression:
Extensive stomach, small bowel, and cecal pneumatosis and mesenteric and portal venous gas secondary to high-grade stenosis/occlusion of the origins of the celiac axis and SMA. There are hypodensities in the spleen concerning for splenic infarct.

Recommendations:
For your training purposes, recommendations are not included in this report.