Findings
Chest radiograph
- Streaky opacities in the left lower lobe, bilateral perihilar regions, and right upper lobe
- Hyperinflation with emphysematous changes
CT
Chest
- Widespread tree-in-bud nodularity in the lower lobes, right middle lobe, and posterior segment of the right upper lobe
- Diffuse bronchial wall thickening
- Advanced destructive emphysema
- Fibrosis with associated traction bronchiectasis in the right upper lobe
- Left paramediastinal scarring
- Trace bilateral pleural effusions
- Moderate-sized, low attenuation pericardial effusion
- Fusiform aneurysmal dilation of the descending aorta at the diaphragmatic hiatus measuring 4.2 cm in diameter
- Mild wall thickening of the midthoracic esophagus with layering intraluminal fluid
- Increased bulk of right hilar lymphoid tissue
- Moderate coronary artery calcification
- Aortic valve calcification
- Moderate-sized hiatal hernia
Upper abdomen
- Mild narrowing at the origins of the celiac artery and SMA with poststenotic dilation of the celiac artery
- Cholecystectomy
- Low density structure in hepatic segment 7 with discontinuous nodular peripheral enhancement
MSK
- Age-indeterminate compression fractures of the C7, T2, T11, and L1 vertebral bodies without bony retropulsion
- Remote right rib fractures
Diagnosis
Aspiration
Pericardial effusion
Sample Report
Multifocal bronchitis/bronchiolitis with small areas of associated pneumonia. Aspiration is likely contributing given the presence of a hiatal hernia and a fluid level in the midthoracic esophagus.
Moderate-sized low attenuation pericardial effusion. Recommend correlation with clinical signs of pericarditis.
Mild fusiform aneurysmal dilation of the descending aorta at the diaphragmatic hiatus.
Areas of scarring in the right upper lobe and left paramediastinal region may relate to prior radiation therapy and/or sequela of prior infection.
Bulky right hilar nodal tissue likely relates to the acute infection. Recommend follow-up CT after treatment to ensure resolution.
Multiple spinal compression fractures, which are strictly age-indeterminate but favored remote.
Hepatic hemangioma.
Discussion