Okay folks. Here is my CT Angio report. I want every nurse, doctor, plumber, painter, etc.... To put on their Dr. House hat and figure this out for me!!!! All labs have been negative. Bronch cytologies, cultures TB were negative. WBCs normal at 7.7. Ana, Ige, HIV, rheumatoid factor, c-met, cbc, blood cultures.....all negative. No fever, no cough, no weird exposures that I know of. Only abnormal on labs was my elevated glucose!! On paper I look like a really healthy person. My only symptom was shortness of breath and hypoxia. Okay........go!!!! CLINICAL DATA: 51-year-old female with increasing shortness of Breath. Cardiac diastolic dysfunction. Abnormal D-dimer. Initial encounter. EXAM: CT ANGIOGRAPHY CHEST WITH CONTRAST TECHNIQUE: Multidetector CT imaging of the chest was performed using the standard protocol during bolus administration of intravenous contrast. Multiplanar CT image reconstructions including MIPs were obtained to evaluate the vascular anatomy. CONTRAST: 100 mL Omnipaque 300. COMPARISON: Chest radiographs from the same day reported separately. FINDINGS: Adequate contrast bolus timing in the pulmonary arterial tree. No focal filling defect identified in the pulmonary arterial tree to suggest the presence of acute pulmonary embolism. In the left lower lung affecting both the lingula and anterior basal segment of the lower lobe there is a mass like opacity measuring 40 x 31 x 25 mm, affecting both sides of the major fissure (series 7 image when 126). There are numerous superimposed solid to the semi solid pulmonary nodules throughout both lungs. Most measure 5-6 mm diameter, the largest are 10-11 mm. These head indistinct margins, resembling ground-glass. Superimposed bilateral mosaic attenuation. Additional more confluent opacity in both costophrenic sulci and dependently along the lateral right major fissure. Superimposed curvilinear probable scarring in the left apex. Major airways are patent. No pericardial or pleural effusion, but there is mediastinal lymphadenopathy in the form of increased size and number of nodes, measuring up to 14 mm short axis individually. Bilateral hilar nodes are less affected. There is cardiomegaly. Negative visualized liver dome and spleen. Thyromegaly with only a subcentimeter right lobe thyroid nodule visible, too small to characterize, but most likely benign in the absence of known clinical risk factors for thyroid carcinoma. Visible aorta and great vessels are patent. No definite aortic atherosclerosis. No acute osseous abnormality identified. Review of the MIP images confirms the above findings. IMPRESSION: 1. No evidence of acute pulmonary embolus. 2. Abnormal lungs with numerous indistinct bilateral pulmonary nodules (semi-solid appearing), with superimposed confluent mass like pulmonary opacity in the left lower lung crossing the major fissure. Favor disseminated infection rather than neoplastic/metastatic disorder. Consider bacterial, fungal, and atypical etiologies (including invasive aspergillosis if the patient is immunocompromised). 3. Mediastinal lymphadenopathy, favor reactive. Study discussed by telephone with (name removed) on 1/6/2015 at 07:31. We discussed contact precautions and further infectious workup. Electronically Signed By:(name removed) M.D. On: 01/06/2015 07:37
Posted on: Thu, 15 Jan 2015 02:23:12 +0000
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