Question

In your own words, what would you say to the patient? Please be sure you cover everything that was seen in his lungs, heart and adrenal glands. DO NOT use medical terminology. You need to discuss calcifications, adrenal adenomas, the coronary artery, cardiomegaly, lymph nodes, and all of the nodules that were listed (mediastinal, pretracheal, precarinal, subcarinal) and the fact that intravenous contrast is now being recommended.

CT OF THE CHEST WITHOUT CONTRAST HISTORY: Shortness of breath. FINDINGS: CT examination of the chest was performed without intravenous contrast enhancement. Median sternotomy has been performed with dense calcifications of the coronary arteries and calcific plaque formation in the aortic arch. There is mild cardiomegaly. The upper pole of the right thyroid lobe demonstrates a 0.8 x 0.6 cm nodule. No enlarged axillary or supraclavicular lymph nodes are evident. There are numerous enlarged mediastinal lymph nodes, including a 1.4 x 1.1 cm pretracheal node on image #17, a 1.9 x 1.7 cm precarinal node on image #24 with marginal calcification, and a 2.1 x 1.6 cm AP window node on image #23. There is a nodal conglomerate in the subcarinal region, which measures 4 x 2 cm. Bilateral hilar adenopathy is present but this is difficult to accurately measure without intravenous contrast to delineate between hilar vasculature and nodal structures. There are a few small ill-defined nodules within the left upper lobe which measure 2-3 mm in diameter. The posterior superior portion of the left lower lobe contains a 1.2 x 0.4 cm pleural plaque (image #38). In both the posterior right base and superior segment of the right lower lobe, there is atelectasis. The aortic descent and visualized portions of the abdominal aorta show moderate calcified plaque formation. No pleural effusion is evident. Within the visualized abdomen, the adrenal glands are both enlarged, measuring 2.1 x 2.5 cm on the left and 1.9 x 3 cm on the right. The adrenals show homogenous low attenuation compatible with bilateral adrenal adenomas. There are numerous bilateral nonobstructive renal calculi. No abdominal nodal enlargement is evident in the visualized portions of the abdomen. IMPRESSION: 1. There is widespread bilateral hilar and mediastinal nodal enlargement. At least some of these nodes show both internal and marginal calcifications, which may suggest a granulomatous process. Further evaluation, which could include both followup and additional evaluation for other enlarged lymph nodes within the body, is suggested. 2. Bilateral low attenuation enlargement of the adrenal glands. This may represent bilateral adrenal adenomas. 3. Evidence of prior surgery of the chest with extensive bilateral coronary artery calcifications. 4. Mild to moderate calcified plaque formation of the descending aorta.

Answer 1

The deposition of calcium in the arteries cause narrowing of vessels. The deposition of fat, cholesterol, calcium in the aortic arch leads to the blockage of the flow results in enlargement of heart. A solid filled lumps were seen in upper pole of the right thyroidand numerous of the similar ones were observed in the mediastinal lymph nodes. Deposition of calcium is also observed in precarinal node. Bilateral enlargement of the lymph nodes of pulmonary hila along with deposition of hyalinized collagen fibers in the parietal pleura located in the posterior superior portion of the left lower lobe resulting in collapse or closure of a lung. Abdominal aorta also seen with calcium deposits show homogenous low attenuation compatible with bilateral adrenal benign tumor. There are numerous bilateral nonobstructive kidney stones. Evidence of prior surgery of the chest with extensive calcium depositions in the bilateral coronary artery along with moderate level deposition of calcium in the descending aorta.