In your own words, what would you say to the patient? Please besure you cover everything that was seen in his lungs, heart andadrenal glands. DO NOT use medical terminology. You need to discusscalcifications, adrenal adenomas, the coronary artery,cardiomegaly, lymph nodes, and all of the nodules that were listed(mediastinal, pretracheal, precarinal, subcarinal) and the factthat intravenous contrast is now being recommended.
CT OF THE CHEST WITHOUT CONTRAST HISTORY: Shortness of breath.FINDINGS: CT examination of the chest was performed withoutintravenous contrast enhancement. Median sternotomy has beenperformed with dense calcifications of the coronary arteries andcalcific plaque formation in the aortic arch. There is mildcardiomegaly. The upper pole of the right thyroid lobe demonstratesa 0.8 x 0.6 cm nodule. No enlarged axillary or supraclavicularlymph nodes are evident. There are numerous enlarged mediastinallymph 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 marginalcalcification, and a 2.1 x 1.6 cm AP window node on image #23.There is a nodal conglomerate in the subcarinal region, whichmeasures 4 x 2 cm. Bilateral hilar adenopathy is present but thisis difficult to accurately measure without intravenous contrast todelineate between hilar vasculature and nodal structures. There area few small ill-defined nodules within the left upper lobe whichmeasure 2-3 mm in diameter. The posterior superior portion of theleft 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 rightlower lobe, there is atelectasis. The aortic descent and visualizedportions of the abdominal aorta show moderate calcified plaqueformation. No pleural effusion is evident. Within the visualizedabdomen, the adrenal glands are both enlarged, measuring 2.1 x 2.5cm on the left and 1.9 x 3 cm on the right. The adrenals showhomogenous low attenuation compatible with bilateral adrenaladenomas. There are numerous bilateral nonobstructive renalcalculi. No abdominal nodal enlargement is evident in thevisualized portions of the abdomen. IMPRESSION: 1. There iswidespread bilateral hilar and mediastinal nodal enlargement. Atleast some of these nodes show both internal and marginalcalcifications, which may suggest a granulomatous process. Furtherevaluation, which could include both followup and additionalevaluation for other enlarged lymph nodes within the body, issuggested. 2. Bilateral low attenuation enlargement of the adrenalglands. This may represent bilateral adrenal adenomas. 3. Evidenceof prior surgery of the chest with extensive bilateral coronaryartery calcifications. 4. Mild to moderate calcified plaqueformation of the descending aorta.
