Demographics:
23 years old, Male
Indication:
Fever, cough
Findings
Chest radiograph
- Dense airspace opacification in the left lower lobe
- Small left pleural effusion
CT
Chest
- Dense consolidation of the left lower lobe with intermixed locules of gas
- Within this area of consolidation is a multilobulated contrast density structure measuring 4.5 cm in anteroposterior dimension that demonstrates direct communication with a left lower lobe pulmonary arterial branch. Several subsegmental branches extend from this collection peripherally
- Clusters of tree-in-bud nodularity in the left upper lobe
- Cystic bronchiectasis in the superior segment of the right lower lobe
- Generalized bronchial wall thickening
- Debris filling left lower lobe bronchi
- Small left pleural effusion
- Multiple mildly enlarged mediastinal and left hilar lymph nodes
Upper abdomen
- No acute findings
MSK
- No acute findings
- Minor anterior wedging of the T10 and T11 vertebral bodies
Diagnosis
Necrotizing pneumonia with pulmonary arterial pseudoaneurysm
Sample Report
Findings concerning for necrotizing pneumonia in the left lower lobe with a large associated pulmonary arterial pseudoaneurysm. Recommend conventional pulmonary arteriogram and possible endovascular coiling.
Tree-in-bud nodularity in the left upper lobe is also concerning for pneumonia.
Cystic bronchiectasis in the right lower lobe, likely postinfectious.
Small left pleural effusion.
Discussion