Case 5 - Importance of Search Pattern in Cases with Multiple Findings

EXAM: XR Chest
CLINICAL INDICATION: SOB and pain
FINDINGS:
Support Devices: None
Lungs/Pleura: No pneumothorax. Low lung volumes with bibasilar opacities. Small
right pleural effusion.
Heart/Mediastinum: Mildly enlarged.
Bones/Soft tissues: No acute osseous abnormality.
IMPRESSION:
Small right pleural effusion with faint bibasilar opacities favored to reflect
atelectasis. Given unilateral pleural effusion and right-sided chest pain,
correlate clinically for pulmonary embolism.

EXAM: CT Chest w/ Contrast
CLINICAL INDICATION: PE Protocol;Acute shortness of breath.
TECHNIQUE:Multiple-row detector helical CT examination of the chest with IV
contrast. Axial, sagittal, and coronal reconstructed images. If applicable,
point-of-care testing was approved following departmental protocol.
COMPARISON: None.
FINDINGS:
Vascular: Evaluation of the pulmonary arteries is diagnostic to the distal
segmental arterial level. Pulmonary embolism within the segmental and
subsegmental branches of the right upper, right middle, and right lower
lobe. The main pulmonary artery is normal in caliber. The aorta is normal in
course and caliber.
Mediastinum: Normal heart size. No pericardial effusion.
Lymph nodes: No pathologically enlarged thoracic lymph nodes.
Airways: Central airways are patent.
Lungs/Pleura: Consolidation with central clearing in the right lower lobe most
consistent with a pulmonary infarct. Small right pleural effusion. Minimal
atelectasis in the dependent left lower lobe. No pneumothorax.
Upper abdomen: Small hiatal hernia.
Bones and soft tissues: Imaged thyroid gland is normal. Mild wedging within the
T7 vertebral body with up to 20% height loss in the inferior endplate and a
nondisplaced sagittally oriented fracture which spares the posterior vertebral
body. Healed right anterolateral inferior rib fracture.

IMPRESSION:
1. Pulmonary embolism within the segmental and subsegmental branches of the
right upper, right middle, and right lower lobe with likely pulmonary infarct in
the right lower lobe with a trace right pleural effusion.
2. Mild cardiomegaly with flattening of the intraventricular septum.
Echocardiogram of provide further evaluation for right heart strain.
3. Mild wedging within the T7 vertebral body with up to 20% height loss in the
inferior endplate and a nondisplaced sagittally oriented fracture which spares
the posterior vertebral body.