Age: 38
Sex: Male
Indication: Cough, chest pain
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Case #29
Findings
Chest radiograph
- Enlarged cardiomediastinal silhouette with notable widening of the superior mediastinum
- Hazy left retrocardiac opacity
- Small pleural effusions
CT
- Chest
- Area of masslike consolidation in the paramediastinal right upper lobe with internal locules of gas
- Extensive contiguous mediastinal fat stranding extending from the thoracic inlet through the infrahilar region without mediastinal gas or defined mediastinal collection
- Large pericardial effusion, measuring 2 cm in width
- Multiple mildly enlarged mediastinal and bilateral hilar lymph nodes, likely reactive
- Calcified mediastinal and right hilar lymph nodes
- Tree-in-bud and groundglass opacities scattered throughout the right lung with interlobular septal thickening
- Moderate-sized bilateral pleural effusions
- Upper abdomen
- No acute findings
- MSK
- No acute findings
Diagnosis
- Mediastinitis
- Pulmonary abscess
Sample Report
Findings concerning for a right upper lobe pulmonary abscess with adjacent mediastinitis. No mediastinal gas or drainable mediastinal fluid collection. Recommend followup imaging after treatment to ensure resolution.
Groundglass opacities and tree-in-bud nodularity throughout the right lung likely relate to atypical infection.
Large pericardial effusion, likely representing reactive pericarditis. Recommend correlation with clinical findings of cardiac tamponade.
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