Wk 5, Case 45 - Review

EXAM: XR Chest 2 Views PA + Lateral
CLINICAL INDICATION: Pneumothorax HIV positive, cough
FINDINGS: Small left pneumothorax is unchanged. There is a nodular, cavitary lesion in the left upper lobe, unchanged from yesterday's exam. Surrounding nodular, bronchocentric opacities are concerning for endobronchial spread of infection. The heart and pulmonary vasculature is normal. No effusions.
IMPRESSION: Cavitary lesion in the left upper lobe concerning for active pulmonary tuberculosis.
Important findings were identified, read back and verified.

EXAM: CT Chest without contrast
CLINICAL INDICATION: Pneumothorax. Cough, fever, immunocompromised
FINDINGS:
SUPPORT DEVICES: None.
VASCULAR: No acute abnormality.
MEDIASTINUM: The heart, trachea and other mobile mediastinal structures are shifted to the right with concern for tension pneumothorax. The thyroid is normal.
LYMPH NODES: No abnormality.
AIRWAYS/LUNGS/PLEURA: The airways are patent. Redemonstrated numerous cavitary nodules and tree-in-bud opacities seen throughout the left upper and bilateral lower lobes. Previously indexed left upper lobe cavitary lesion now measures 1.7 x 1.6 cm (series 2, image 46). There is a large left-sided pneumothorax involving greater than 60% of the left hemithorax with deviation of the mobile mediastinal structures to the right concerning for tension pneumothorax. Pleural tethering is noted in 2 locations superiorly.
VISUALIZED ABDOMEN: No acute abnormality.
BONES/SOFT TISSUES: No acute abnormality.
IMPRESSION:
1. Large left-sided tension pneumothorax. Correlate clinically for signs of tamponade physiology.
2. Redemonstrated multiple left upper and bilateral lower lobe cavitary lesions with tree in bud opacities concerning for likely tuberculosis given the clinical history. Again, other differential considerations would include atypical mycobacteria, fungal, and bacterial etiologies.
RECOMMENDATION: As above.
COMMUNICATION: Important information was identified.