Demographics:
72 years old, Male
Indication:
Neutropenic fever
Findings
Chest radiograph
- Bilateral mass-like pulmonary opacities. The largest in the right lung base has internal rounded lucencies
- Right IJ approach Port-A-Cath with tip overlying the right atrium
- Thoracic aortic atherosclerosis
- Coronary stent
- Rounded density projecting superior to the left clavicle, which may be external to the patient
CT
Chest
- Mass-like areas of consolidation in the both upper lobes and in the right middle lobe
- Within the area of consolidation in the right middle lobe is a loculated fluid and gas collection measuring 3.5 x 2.5 cm in transaxial dimensions
- Rounded fluid attenuation within the area of consolidation in the left upper lobe suggestive of central necrosis
- Possible additional area of cavitation in an area of consolidation in the posterior segment of the right upper lobe
- Scattered bilateral groundglass opacities with a dependent gradient
- Widespread interlobular septal thickening
- Mild centrilobular emphysema
- Moderate right and small left pleural effusions
- Right IJ approach Port-A-Cath with tip in the right atrium
- Coronary artery calcifications and stents
- Thoracic aortic atherosclerosis without aneurysm
Upper abdomen
- No acute findings
- Cholelithiasis
MSK
- No acute findings
Diagnosis
Mixed bacterial and fungal pneumonia
Sample Report
Multiple areas of mass-like consolidation in both upper lobes and the right middle lobe concerning for multifocal pneumonia, which given imaging appearance and patient history raises concern for opportunistic (including fungal) pneumonia.
Areas of intrapulmonary abscess formation in the right middle lobe, left upper lobe, and possibly right upper lobe.
Interstitial and alveolar pulmonary edema.
Moderate right and small left pleural effusions.
Discussion
References