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Age: 38

Sex: Male

Indication: Cough, chest pain

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Case #17


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.


Discussion



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Images

Right upper lobe abscess with adjacent mediastinal fat infiltration. Notice how poorly defined the mediastinal vessels are, including the aortic arch.



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