Presentation
Recent NSTEMI on background COPD, IHD and CCF. Worsening SOB for one day with epigastric/chest pain. Known history of recurrent PE.
Patient Data
Normal contrast enhancement of the pulmonary trunk, right and left main pulmonary arteries as well as the segmental and proximal subsegmental pulmonary arteries. Suboptimal opacification of the distal subsegmental pulmonary arteries achieved.
The lungs demonstrate diffuse interlobular septal thickening with associated groundglass opacification, which is new from previous CT. The current imaging morphology suggests a "crazy paving type pattern" throughout both lungs.
Bilateral pleural effusions noted ( right larger than left ).
Pretracheal, paratracheal and subcarinal lymphadenopathy noted \X96\ largest measuring 17 mm x 12 mm in the subcarinal region. Mild degenerative spondylosis demonstrated along the thoracic spine without any regions of high-grade canal or neural foramen stenosis.
Conclusion
- No central pulmonary emboli demonstrated, however, suboptimal opacification of the distal subsegmental arteries achieved.
- Both lungs demonstrate a diffuse "crazy paving type pattern". In the acute setting, etiologies to consider would include pulmonary edema, pulmonary hemorrhage, pulmonary alveolar proteinosis, acute interstitial pneumonitis and diffuse alveolar damage. Respiratory consultation advised.
Case Discussion
This case was demonstrated to be from congestive cardiac failure.
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