Wk 4, Case 38 - Review

EXAM: XR Chest
CLINICAL INDICATION: Suspected Sepsis; Other.
FINDINGS:
Support Devices: None.
Lungs/Pleura: Rounded mid left lung faint opacity. Patchy left base opacities. Mild bibasilar atelectasis and lower lung interstitial prominence. No large pleural effusion or pneumothorax.
Heart/Mediastinum: Unchanged.
Other: None
IMPRESSION:
1. Left midlung rounded opacity may reflect airspace disease, pulmonary lesion not excluded. Chest CT could be considered for further evaluation.
2. Patchy left base atelectasis versus additional airspace disease.
3. Mild pulmonary edema.

EXAM: CT Chest w/ Contrast
CLINICAL INDICATION: Pulmonary embolism.
TECHNIQUE: Multiple-row detector helical CT examination of the chest with IV contrast. Axial, sagittal, and coronal reconstructed images. If applicable, point-of-care testing was approved following departmental protocol.
COMPARISON: None.
FINDINGS:
Vascular: Evaluation of the pulmonary arteries is diagnostic to the subsegmental arterial level. No pulmonary embolism. The main pulmonary artery is normal in caliber. The aorta is normal in course and caliber.
Mediastinum: Normal heart size. No pericardial effusion.
Lymph nodes: Enlarged mediastinal and hilar lymph nodes including a prevascular lymph node measuring up to 2.7 x 2.3 cm (image 78). Subcarinal lymph nodes measure at least 5.6 x 2.5 cm (image 97).
Airways: Central airways are patent.
Lungs/Pleura: Masslike consolidation in the left upper lobe measures up to 5.2 x 3.4 cm ( image 89). Trace left pleural effusion. Dependent atelectasis in the lower lobes. Biapical scarring. No pneumothorax.
Upper abdomen: Mild left adrenal thickening without discrete nodule where seen.
Bones and soft tissues: Imaged thyroid gland is normal. No acute osseous abnormality.
IMPRESSION:
1. Significant mediastinal lymphadenopathy suspicious for malignancy. Given the nodes narrow the hilar vessels without associated occlusion, lymphoma is favored with metastatic disease a possibility. Masslike consolidation in the left upper lobe which may reflect primary lung cancer versus pneumonia.
2. No pulmonary embolism.