CT Case Review for Nuclear Medicine Physicians Tuesday, June 7, 2011 CT of the Abdomen – Cases 26-37
CT Workshop for the Nuclear Medicine Physician 58th SNM A Annuall M Meeting ti San Antonio, TX June 7th – 8th, 2011
Cases 38-50 CT of the Chest Drew Torigian, MD
Case 38 41 year old woman with end-stage renal disease and decreased oxygen saturation. CT reveals extensive alveolar consolidation with interlobular septal thickening and air bronchograms, small pleural effusions, a 2 cm calcified hypoattenuating thyroid nodule, a central hypoattenuating filling defect in a right lower lobar pulmonary arterial branch due to acute pulmonary embolism, embolism aortic valvular calcification, and coronary arterial calcification. What is the most likely etiology of the pulmonary consolidation? A. B. C. D.
Bacterial pneumonia Diffuse alveolar hemorrhage (DAH) Pulmonary edema Multifocal bronchioloalveolar cell lung carcinoma
Drew Torigian, MD
CT Case Review for Nuclear Medicine Physicians Tuesday, June 8, 2010 CT of the Abdomen – Cases 26-37 Case 39 38 year old man with acute SVC syndrome. CT shows a 7 cm heterogeneous partially calcified anterior mediastinal mass with extension into superior vena cava and left brachiocephalic vein, a hypoattenuating filling defect in the right internal jugular vein, mild mediastinal lymphadenopathy, scattered subcm pulmonary nodules, and several small hypoattenuating yp g hepatic p lesions.
What is the most likely diagnosis? A. Mediastinal germ cell tumor B. Thymic carcinoma C. Leiomyosarcoma D. Thyroid carcinoma
Case 40 62 year old man with h/o remote trauma. CT demonstrates a defect in the anterior diaphragm, bowel, fat, and ascitic fluid in the right hemithorax, contralateral mediastinal shift, and patchy atelectasis in the right lung.
What is the most likely diagnosis? A. Post-traumatic diaphragmatic hernia B. Bochdalek hernia C. Morgagni hernia D. Hiatal hernia
Case 41 22 year old man status post motor vehicle accident 1 month ago, now with cerebrovascular accident and ventilator-dependent. CT reveals multifocal pulmonary consolidation and ground glass opacity, subpleural air cysts, several regions of mild bronchiectasis, collapse of the bronchus intermedius and proximal right lower lobar bronchi, pneumothoraces, small pleural effusions, a tracheostomy tube, a feeding tube, bilateral chest tubes,, a right g subclavian central venous catheter,, a percutaneous p gastrostomy tube, and an IVC filter.
What is the most likely diagnosis? A. Multifocal bacterial pneumonia B. Adult respiratory distress syndrome (ARDS) with sequelae of barotrauma C. Cryptogenic organizing pneumonia (COP) D. Pneumocystis jiroveci pneumonia
Drew Torigian, MD
CT Case Review for Nuclear Medicine Physicians Tuesday, June 8, 2010 CT of the Abdomen – Cases 26-37 Case 42 56 year old woman with dyspnea on exertion. CT shows a 5 cm lobulated soft tissue mass involving the distal trachea, right mainstem bronchus, and mid esophagus, degenerative change of the thoracic spine, and multiple hepatic cysts.
What is the most likely y diagnosis? g A. Primary tracheal malignancy B. Tracheal papilloma C. Esophageal carcinoma D. Bronchogenic cyst
Case 43 31 year old woman with chest pain and shortness of breath. CT demonstrates moderate pleural and pericardial effusions, mild pericardial enhancement, and atelectasis in the lower lobes, right middle lobe, and lingula.
What is the most likely diagnosis? A. Metastatic disease B. Viral serositis C. Dressler’s syndrome D. Congestive heart failure (CHF)
Case 44 558 year old man with an abnormal chest radiograph. CT reveals peripheral reticular interstitial lung disease with reticulation, interlobular septal thickening, traction bronchiectasis, and honeycombing, along with diffusely decreased hepatic attenuation due to diffuse hepatic steatosis. What is the most likely diagnosis?
A. Acute interstitial pneumonitis (AIP) B. Nonspecific interstitial pneumonitis (NSIP) C. Desquamative interstitial pneumonitis (DIP) D. Usual interstitial pneumonitis (UIP)
Drew Torigian, MD
CT Case Review for Nuclear Medicine Physicians Tuesday, June 8, 2010 CT of the Abdomen – Cases 26-37 Case 45 55 year old woman with weakness, cough, fever, chills, and blood tinged sputum. CT shows a 9 cm infiltrative right hilar soft tissue mass predominantly involving the distal right mainstem bronchus and bronchus intermedius, consolidation and volume loss of the right lower lobe, scattered nodular opacities in the lungs, mild paraseptal and centrilobular emphysema, a small right pleural effusion, and dextroscoliosis of the thoracic spine. What is the most likely diagnosis? A. Endobronchial metastasis B. Carcinoid tumor C. Lung carcinoma D. Lymphoma
Case 46 27 year old man with shoulder pain and an abnormal chest radiograph. CT demonstrates supraclavicular and mediastinal lymphadenopathy, a 5 mm nodule in the right lower lobe, and a 1 cm hypoattenuating lesion in the spleen.
Wh t is What i the th mostt likely lik l diagnosis? di i ? A. Sarcoidosis B. Lymphoma C. Fungal infection D. Metastatic disease
Case 47 50 year old man with h/o chronic lymphocytic leukemia presents with shortness of breath, cough, and decreased oxygen saturation despite antibiotic therapy. CT reveals multifocal pulmonary consolidation and ground glass opacity, bilateral axillary and mediastinal lymphadenopathy, coronary arterial calcification, degenerative change of the thoracic spine, hepatomegaly, and upper retroperitoneal lymphadenopathy lymphadenopathy. What is the most likely etiology of the pulmonary disease? A. Viral pneumonia B. Multifocal bronchioloalveolar cell lung carcinoma (BAC) C. Diffuse alveolar hemorrhage (DAH) D. Silicosis
Drew Torigian, MD
CT Case Review for Nuclear Medicine Physicians Tuesday, June 8, 2010 CT of the Abdomen – Cases 26-37 Case 48 33 year old woman with h/o thalassemia. CT shows bilateral posterior mediastinal soft tissue masses, diffuse osteopenia with thickened medullary trabeculae, infiltrative soft tissue in the hepatic hilum, hepatomegaly with patchy hepatic steatosis, and right hydronephrosis.
What is the most likely y diagnosis? g A. Extramedullary hematopoiesis (EMH) B. Plexiform neurofibromas C. Ganglioneuromas D. Lymphoma
Case 49 55 year old man with h/o multiple myeloma. CT demonstrates posterior mediastinal, retrocrural, and upper retroperitoneal lymphadenopathy with anterior displacement of the aorta, extensive soft tissue infiltration of the retroperitoneal fat and fascial planes, a 3 cm left adrenal nodule, coronary arterial calcification, and degenerative change of the thoracic spine.
What is the most likely diagnosis? A. Metastatic retroperitoneal sarcoma B. Multicentric Castleman’s disease C. Plasmacytomas D. Chloromas
Case 50 65 year old woman h/o tobacco use presents with eosinophilia, fever, sweats, chills, dry cough, and dyspnea on exertion. CT reveals peripheral multifocal pulmonary consolidation with air bronchograms, mild bilateral hilar lymphadenopathy, aortic valvular calcification, coronary arterial calcification, and degenerative change of the thoracic spine.
What is the most likely diagnosis? A. Helminthic infection B. Pulmonary lymphoma C. Pulmonary infarcts D. Chronic eosinophilic pneumonia (CEP)
Drew Torigian, MD
CT Case Review for Nuclear Medicine Physicians Tuesday, June 8, 2010 CT of the Abdomen – Cases 26-37
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Drew Torigian, MD