Lungs (airways, pleura)
No axillary, hilar, mediastinal, or paratracheal lymphadenopathy.
Heart size is normal. No pericardial effusion. Great vessels are unremarkable. No evidence of calcific coronary atherosclerosis or valvular calcifications.
Within the visualized upper abdomen, the liver, gallbladder, pancreas, spleen, kidneys and adrenal glands are within normal limits. No retroperitoneal or mesenteric lymphadenopathy. No free fluid or free air seen.
The visualized osseous structures are unremarkable. No suspicious sclerotic or lytic lesions observed.
Chest wall is unremarkable.
CT PULMONARY ANGIOGRAM
TECHNIQUE: After timed intravenous administration of a contrast bolus, contiguous axial slices with 2 mm and 5 mm collimation were obtained from lung apices to mid-kidneys. Right and left coronal oblique reconstructions done.
FINDINGS: The pulmonary arteries are well-opacified to the subsegmental level. No filling defects or other evidence of pulmonary embolism from the main pulmonary trunk to the subsegmental pulmonary arteries. Pulmonary trunk is of normal caliber.
CT AORTIC ANEURYSM STUDY
TECHNIQUE: Contiguous axial images from base of neck to ischial tuberosities both with and without contrast using 3 mm collimation and 1.5 mm collimation. Coronal and sagittal reconstructions as well as a 3D reconstruction of aorta and its branches.
FINDINGS: The prosthetic aortic graft extending from the base of the aorta to the hemi-arch is intact. No leakage observed.
Redemonstration of aortic dissection from distal end of the graft extending to the external iliac arteries bilaterally, at approximately the level of S1. The internal iliacs are not affected. Previously, the dissection extended to the T12 level. Therefore, this represents an extension of the dissection distally.
The dissection also extends superiorly to the left subclavian and left common carotid arteries. The right brachiocephalic trunk is not affected.
The true lumen is smaller than the false lumen and supplies most of the branches originating from the aorta. No identified compromise in perfusion to organs. The false lumen is also well opacified with contrast indicating significant blood flow.
Contiguous axial images using 5 mm collimation from lung apices to mid-kidneys following intravenous administration of contrast. Also, high-resolution CT of chest using 1 mm collimation at 10 mm intervals following intravenous administration of contrast.
Implantable cardioverter defibrillator is present in the right anterior chest wall with leads terminating in the right atrium and right ventricle.
Interval development of multifocal centrilobular nodules that are consistent with bronchiolitis.
Multifocal centrilobular nodules consistent with bronchiolitis affecting the right upper and middle lobes, and the lingula to a lesser extent. Associated bronchial wall thickening is also seen. Soft tissue infiltration surrounding the central right lower and middle lobe bronchi may relate to an infectious/inflammatory process, although malignancy cannot be excluded. Follow up CT recommended after appropriate antimicrobial therapy.
An irregular soft tissue nodule measuring 1.2 cm x 0.7 cm is located in the right upper lobe (image 23). It has a pleural tag. Although the spiculated features are worrisome, the lesion is likely benign given the patient's young age.
Pulmonary nodules identified on previous chest CT (12/04/2006) are stable. No new nodules seen.
Stable nodules, less than 3 mm in diameter, are present in the right upper lobe. These nodules have remained stable since the CT pulmonary angiogram in 6/05.
A calcified granuloma measuring 0.5 cm located in the lingula lobe is present. This is a benign lesion and requires no follow up.
Numerous scattered, small centrilobular nodules consistent with bronchiolitis, and a single small area of right basilar air-space disease are present and may have an inflammatory/infectious etiology.
Redemonstration of infiltrative soft tissue mass involving the mediastinum and adjacent right hilum, and extending into the paratracheal, subcarinal, and precarinal spaces. It also appears to encase the main bronchi bilaterally. No endoluminal lesion seen. The lesion measures 6.5 cm x 4.8 cm (previously 7.4 cm x 5.0 cm).
Redemonstration of increasing mass effect on superior vena cava with stenosis and resultant prominent bronchial arteries and enhancement of the azygous system. There is focal mass effect by lymphadenopathy on the azygous vein (the pathologic lymph node measures 1.3 cm in short axis). There is mild improvement of the lumen of the right upper lobe bronchus from prior exam and even more marked improvement from the scan before that.
Redemonstration of postoperative changes consistent with left upper lobe wedge resection. Redemonstration of soft tissue mass at suture line in left upper lobe stable dating back to at least March 2006. This likely represents fibrosis or organized atelectasis. This could be further evaluated with PET/CT if concerned about local tumor recurrence.
Note is made of central soft tissue infiltration in the right tracheobronchial tree surrounding the central right lower lobe and middle lobe bronchi. This finding is new since the previous CT pulmonary angiogram done in 05/2006.
Ground glass opacity in the right lower lobe may be post inflammatory. The walls of the right bronchial tree are mildly thickened.
Ill-defined centrilobular nodules, including tree in bud opacities, and acinar opacities in the right upper lobe, predominantly the posterior segment. To a lesser extent, these lesions are also found in the left lower lobe and right lower lobe.
Minimal basilar honeycombing consistent with subpleural basilar fibrosis or early usual interstitial pneumonitis.
Bilateral lower lobe bronchiectasis and bronchial wall thickening, with left side worse than right. Surrounding bronchiolitis present.
The left anterior descending artery is mildly diffusely calcific consistent with atherosclerosis.
Calcific atherosclerosis is present in the left anterior descending artery.
There is also annular calcification of the mitral valve.
The pulmonary artery trunk measures 3.4 cm in diameter, suggestive of pulmonary artery hypertension.
Indeterminate subcentimeter low-density lesion in the liver. Likely hemangioma or cyst.
Small low-density lesion in liver consistent with focal fatty infiltration, perfusion delay or cyst.
Within the abdomen, the gallbladder is absent and cholecystectomy clips are present.
There is likely splenomegaly with the spleen measuring 15.6 cm in the anterior-posterior direction, and 7 cm in the oblique dimension. There are no increased collateral vessels.
There is a renal cortical defect in the mid-pole of the left kidney, that likely relates to previous infection or infarction.
No suspicious sclerotic or lytic lesions.
Stable low-attenuation lesions with well-corticated borders are seen in a number of vertebral bodies.
Focal areas of osteopenia in the spine are stable.
The visualized spine exhibits degenerative changes at multiple levels. Noted are large anterior osteophytes.
An asymmetric soft tissue lesion is present in the right breast, measuring 3.5 cm x 1.8 cm, and exhibits spiculated borders. There is a small focus of calcification within it. This lesion is suspicious for breast cancer and correlation with mammography is recommended.
Post-surgical changes in the right axilla.
Redemonstration of asymmetric thyroid, with the right lobe larger than the left. The left lobe has a stable low density lesion.
Single pulmonary nodule. Repeat follow up CT scan in six months recommended to establish growth pattern and determine malignant potential.
A 4 mm pulmonary nodule is located in the right upper lobe adjacent to the chest wall. Given the patient's relatively high risk for lung cancer, and based on the nodule's size and current imaging recommendations, the nodule should be followed in twelve months to establish its growth pattern and determine malignant potential.
Mediastinal lipomatosis. No evidence of thymoma or thymic hyperplasia. Note that follicular thymic hyperplasia seen in patients with myasthenia gravis does not necessarily result in an imaging abnormality since it is a microscopic diagnosis.
Redemonstration of right middle lobe atelectasis. There is some mass effect on the middle lobe bronchus with distal obliteration. Bilateral multifocal patchy air space disease has shown interval worsening. Redemonstration of surrounding ground glass opacity. There is diffuse peribronchovascular thickening particularly along the central tracheobronchial tree. Redemonstration of scattered ground glass opacities predominantly in the lower lungs. bilateral septal thickening consistent with interstitial edema.
Multi-focal nodular opacities are present predominantly in the lower lungs. Diagnostic possibilities include an inflammatory process or localized edema.
Stable right middle lobe atelectasis. There is mass effect on the middle lobe bronchus with distal obliteration of the bronchus. Endoluminal lesion cannot be exlcuded. Endoscopy can be performed for furher evaluation
Interval worsening of lingular air space disease. Some multi-focal nodular opacities predominantly in lower lungs and multi-focal ground glass opacities consistent with inflammatory process.
Interlobular septal thickening and new small right pleural effusion. Also peribronchovascular thickening along central tracheobronchial tree could relate to interstitial pulmonary edema. Recommend follow up.
The aorta extending from the root to the descending aorta is ectatic. The root measures 3.5 cm in diameter, ascending aorta 3.9 cm, descending aorta 2.9 cm. There is a small fusiform aneurysm off the distal abdominal aorta just proximal to the bifurcation and ectasia of the proximal common iliac arteries bilaterally. Extensive atherosclerosis is present. No evidence of dissection or ulceration of the posterior wall.
A large mass is present in the thorax encasing the descending aorta and effacing the esophagus. Left lower lobe bronchus is surrounded and left lower lobe is totally ectatic and consolidated. The left lower lobe pulmonary artery is totally encased.
Mild centrilobular emphysema with upper lobe predominance is present bilaterally.
The pulmonary artery is dilated measuring 3.8 cm in diameter suggestive of pulmonary artery hypertension.
The gallbladder is not seen and may be either contracted or removed surgically. Liver, pancreas, spleen, kidneys and adrenal glands are within normal limits. No retroperitoneal or mesenteric lymphadenopathy. The visualized loops of small and large bowel are unremarkable. No free air or free fluid within the abdomen or pelvis.
Degenerative disc disease is present at multiple levels in the spine with prominent anterior osteophytes.
1. Small fusiform aneurysm of distal abdominal aorta. Ectasia of the thoracic aorta from root to descending aorta and ectasia of proximal common iliac arteries bilaterally.
2. Extensive atherosclerosis. Redemonstration of large mass and infarcts encasing the descending thoracic aorta, left lower lobe bronchus and left lower lobe pulmonary artery. Left lower lobe is atelectatic and consolidated.
3. Degenerative disc disease at multiple levels.
FINDINGS: Within the bronchus intermedius (image 58), there is a 2-3 mm density probably representing secretions. A less likely possibility is an endobronchial nodule.
IMPRESSION: Likely secretions in bronchus intermedius. Less likely possibility of endobronchial nodule. Recommend follow-up CT.
Within the lungs, there is mild interstitial edema (ground-glass opacity, peribronchial thickening, and septal thickening).