Age: 22
Sex: Male
Indication: Status post PEA arrest
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Case #24
Findings
Chest radiograph
- Markedly enlarged cardiopericardial silhouette with a bulbous contour
- Streaky bibasilar opacities with additional faint rounded opacities
- Mild diffuse interstitial thickening
- Small right pleural effusion
- Surgical changes of median sternotomy and aortic valve replacement
- Right IJ approach tunneled dialysis catheter with tip overlying the right atrium
CT
- Chest
- Large pericardial effusion, with fluid measuring higher attenuation than water and areas of loculation or blood clot formation superiorly
- Resultant mass effect on the heart with apparent partial collapse of the right ventricle
- Aortic valve replacement with thickening of the commissures on either margin of the noncoronary cusp and nodular filling defects along the right coronary cusp
- Multifocal bilateral lobar, segmental, and subsegmental pulmonary emboli
- Dilation of the main pulmonary artery
- Reflux of contrast material into the IVC and hepatic veins
- Right IJ approach dialysis catheter with tip in the right atrium and adherent thrombus noted along the tip of the catheter
- Multifocal areas of consolidation, some of which have a nodular configuration, throughout both lungs with volume loss and consolidation in the left greater than right lower lobes
- Widespread interlobular septal thickening
- Small bilateral pleural effusions with small volume fluid tracking along both major fissures
- Upper abdomen
- Partially imaged marked enlargement of the spleen with a large intraparenchymal, multiseptated collection
- Hepatic steatosis
- MSK
- Body wall edema
- Median sternotomy changes
Diagnosis
- Endocarditis with septic embolic disease
- Pericardial effusion
Sample Report
Complex large pericardial effusion, likely related endocarditis as discussed below, with mass effect on the right ventricle and reflux of contrast material into the IVC and hepatic veins, raising concern for impaired right heart function. Recommend correlation with clinical signs of cardiac tamponade.
Findings are concerning for endocarditis involving the prosthetic aortic valve with extensive bilateral septic emboli manifesting as both pulmonary arterial filling defects and peripheral nodular pulmonary opacities. Dilation of the main pulmonary artery suggests resultant pulmonary arterial hypertension.
Thrombus at the tip of the right IJ approach dialysis catheter, which is a potential nidus for infection.
Multiseptated collection in the spleen, partially imaged, which raises concern for a splenic abscess. Recommend dedicated abdominal imaging for further evaluation.
Dependent consolidation in both lower lobes likely represents aspiration or pneumonia.
Mild interstitial pulmonary edema with small bilateral pleural effusions.
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