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Age: 58

Sex: Female

Indication: Dyspnea

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Case #8


Findings

Chest radiograph

  • Widespread bilateral interstitial and alveolar opacities
  • Thoracic aortic atherosclerosis

CT

  • Chest
    • Multifocal patchy groundglass opacities and interlobular septal thickening (“crazy paving” pattern)
    • Small right greater than left pleural effusions
    • Thoracic aortic atherosclerosis without aneurysm
    • Mild coronary artery calcification
    • Mildly enlarged prevascular lymph nodes in the superior mediastinum, likely reactive
    • 1.6 cm right thyroid nodule
  • Upper abdomen
    • No acute findings
  • MSK
    • No acute findings


Diagnosis

  • Acute respiratory distress syndrome (ARDS)

Sample Report

Multifocal patchy bilateral interstitial and airspace disease for which differential considerations include multifocal pneumonia, ARDS, and alveolar proteinosis. Recommend followup chest CT after treatment to monitor progression.

Small right greater than left pleural effusions.

1.6 cm right thyroid nodule. Recommend nonemergent thyroid ultrasound for further evaluation if not previously performed.


Discussion



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Images

Initial chest CT in this patient shows peripheral groundglass opacities and interlobular septal thickening in a crazy paving pattern, consistent with exudative phase of ARDS, though there could be coexisting pneumonia. Chest CT 2 weeks later shows increased interstitial and alveolar disease with suggestion of some early reticular changes, likely recurrent exudative phase superimposed on proliferative phase. Chest CT 2 months from the initial study shows decreased opacities with residual subpleural reticulation, particularly anteriorly, with mild traction bronchiectasis consistent with fibrotic phase. Chest CT 9 months after the initial study shows decreased, mild residual anterior subpleural reticulation with associated traction bronchiectasis.



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