Age: 77
Sex: Male
Indication: Chest pain, dyspnea
Save ("V")
Case #8
Findings
Chest radiograph
- Streaky bibasilar opacities
- Mildly enlarged cardiopericardial silhouette
- Thoracic aortic atherosclerosis
- Dual lead left subclavian approach ICD with leads projecting in the right atrium and right ventricle
CT
- Chest
- Nonocclusive subsegmental pulmonary embolism in the right lower lobe
- Basal inferior wall left ventricular pseudoaneurysm with peripheral mural thrombus and calcification
- Small pericardial effusion
- Thoracic aortic atherosclerosis without aneurysm
- Moderate coronary artery calcification
- Left subclavian approach ICD with leads in the right atrium and right ventricle
- Widespread bronchial wall thickening with multifocal bronchial plugging
- Confluent centrilobular emphsyema
- Right greater than left dependent groundglass opacities
- Subcentimeter hypodense thyroid nodules
- Upper abdomen
- Pneumobilia (patient had a history of sphincterotomy)
- Cholecystectomy
- Thickening of the right adrenal gland
- MSK
- Healing nondisplaced fractures of the right anterior fifth and sixth ribs
- Left infraspinatus intramuscular lipoma
Diagnosis
- Subsegmental pulmonary embolism
- Left ventricular pseudoaneurysm
Sample Report
Nonocclusive subsegmental pulmonary embolism in the right lower lobe.
Left ventricular pseudoaneurysm arising from the basal inferior wall with peripheral thrombus and mural calcification. Recommend correlation with any available prior imaging to document stability. Further imaging followup can be dictated by outpatient cardiology referral.
Findings suggestive of infectious or inflammatory bronchitis. Dependent groundglass opacities in the right greater than left lungs are favored to represent atelectasis.
Pneumobilia, which is not unexpected in this patient with history of sphincterotomy. Laboratory analysis and dedicated abdominal imaging could provide further evaluation if there is clinical concern for an acute abdominal pathology.
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