Monday, May 01, 2006

Abnormal CT scan

72 year opld with severe COPD developed right sided pleuritic chest pain. No fever chills or increased shortness of breath.
A chest xray at baseline is shown here:

A chest xray with the pain is shown here:

Based on that CXR, he was diagnosed with RUL pneumonia and prescribed a Z-Pak. His pain pertsisted. A month later a f/u chest CT was done. Other than severe upper lobe emphysema, the pertinent slice is shown here:

Any comments?

3 comments - CLICK HERE to read & add your own!:

Anonymous said...

There is a lot of pleural reaction and a very peripheral infiltrate on the CT. I could not appreciate any plaques on the other films and the pleural-based inflammation seems very focal. COPD with CAP and pleuritis?

Arenberg said...

I think your patient may have had a PE. The pleural based density could be organizing infarct.

Jennings said...

Good point and my thought as well. Ironically, this is the one patient that the ER didn't get a PE-protocol CT on. CT has been ordered now, but we are 2 months later and he is asymptomatic so not sure of the yield anymore.