Presentation: 50 year-old male with left lower quadrant pain.

Key findings:

• Inflamed sigmoid diverticulum
• Pericolonic fat stranding/inflammation
• Hepatic steatosis
• Nonobstructing left calyces stone
• Several borderline enlarged lymph nodes (epicardial, retroperitoneal, inguinal)

Diagnosis:

1. Acute uncomplicated diverticulitis.
2. Few borderline enlarged lymph nodes could be a chronic, reactive finding or indicate lymphoproliferative disorder. It would be reasonable to biopsy the left inguinal lymph node under ultrasound if this patient does not have prior imaging to show these are stable.
3. Hepatic steatosis.

Comment: The "uncomplicated" part of the diagnosis refers to no abscess, fistula, perforation/free air, thrombophlebitis of the SMV/PV, or liver abscess.

Management: Medical (antibiotics, bowel rest).