40 year old female presents to a DC office complaining of non-specific lower discomfort. No prior history of trauma, surgery, carcinoma or corticosteroid/opioid regimen.
In the RUQ, multiple ring -enhanced radiolucencies are present – all intraperitoneal in location.
Spinal changes include: L4 degenerative spondylolisthesis, L5 disc narrowing, mild SI disease.
1. CHOLELITHIASIS – RUQ
2. L2 SPONDYLOSIS WITH RETROLISTHESIS.
3. L4 L4 DEGENERATIVE SPONDYLOLITHESIS.
4. L5 DISC NARROWING.
Only 15%–20% of gallstones have enough calcium within to be visible on plain x-rays therefore radiographs underestimates the number of stones present. (3) This necessitates a follow up examination with diagnostic ultrasound examination of the abdomen.