Case

An 83 year old patient comes to the pulmonology division complaining of shortness of breath with any physical activity, persistent fatigue, and periods through the day where they reports having rapid and somewhat irregular heartbeat. Physical examination is otherwise unremarkable. A CT scan is ordered.

 

Question 3/3 - What condition(s) do you think this patient has?

Click on your selected option(s) below  (correct = 2, over-thinking = 3+)

Case Complete

Correct (well highly likely). While we do not see an aneurysm directly at this CT scan level, there is indication of bleeding which would be consistent with a leaking aneurysm. Some form of cardiopulmonary dysfunction is also present (possibly congestive heart failure)

Incorrect. The pulmonary arteries/veins appear to be in a normal position and the great vasculature is in the center. With pneumothorax the heart is usually displaced laterally due to the collapsed lung on one side. To be definitive, we would want to change the image to a lung window (i.e. increase the brightness to better see the boundaries of soft tissue of the lung).

An example of different intensity windows is shown below.

Correct! There is intermediate grey along the posterior right wall of the thorax. This could be a pleural effusion or a hemothorax.  Either would be consistent with the patient presentation and imaging.

Incorrect. Cardiac tamponade is a condition where extra fluid (usually blood) accumulates in the pericardial space causing pressure on the heart. The CT scan is from a level superior to the heart so we have no information on possible tamponade.