Case 1 - Orogastric Tubes

PROCEDURE: CT Chest w/o Contrast
CLINICAL INDICATION: Abnormal chest xray Rapid cardiopulmonary decompensation in
the setting of new onset heart failure.
TECHNIQUE: Non-gated spiral axial images of the chest were obtained without
intravenous contrast.
FINDINGS:
MEDIASTINUM/HEART/VESSELS:
Imaged thyroid is unremarkable. Multiple prominent mediastinal lymph nodes with
an enlarged lymph node measuring 13 x 11 mm in the AP window (series 2 image 42)
and 22 x 11 mm in the subcarinal station (series 2 image 56). Heart size is
normal. Small pericardial effusion. Thoracic aorta is normal in course and
caliber. Main pulmonary artery is normal in course and caliber. Esophagus is
unremarkable. Right IJ catheter terminates in the right atrium. Left IJ catheter
terminates in the main pulmonary artery. Right femoral catheter terminates in
the right atrium. Endotracheal tube present. Gastric tube terminates in the
stomach. Foci of air are present in the right atrium/atrial appendage, main
pulmonary artery and right ventricle.
AIRWAY/LUNGS/PLEURA:
Central airways are patent. No pleural effusion or pneumothorax. Confluent areas
of peripheral consolidation in the posterior right lower lobe with central
groundglass opacity. Groundglass opacity and consolidation in the anterior right
middle lobe. Trace bilateral pleural effusions. Adjacent atelectasis in the
dependent left lower lobe.
VISIBLE ABDOMEN:
Partially imaged intra-abdominal free fluid and pneumatosis intestinalis. Please
refer to the separately dictated CT of the abdomen and pelvis obtained on the
same day for findings below the diaphragm.
SOFT TISSUES/BONES:
Prominent bilateral supraclavicular lymph nodes with an enlarged lymph node on
the right measuring 13 x 12 mm (series 2 image 18). No aggressive osseous
lesions.
IMPRESSION:
1. Foci of air present in the right atrium/atrial appendage, right ventricle and
right ventricular outflow tract. Correlate with recent
procedure/instrumentation.
2. Right middle/lower lobe peripheral consolidation could represent pulmonary
infarct, possibly due to air embolism.
3. Multistation mediastinal and supraclavicular lymphadenopathy. Nonspecific and
could be reactive in etiology.
4. Partially imaged intra-abdominal free fluid and pneumatosis intestinalis.
Please refer to the separately dictated CT of the abdomen and pelvis obtained on
the same day for findings below the diaphragm.