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4. Unenhanced thoracic CT shows lingular and left lower lobe consolidation associated with a small-to-moderate left pleural effusion
The unenhanced thoracic CT confirms the chest radiographic findings of lingular and left lower lobe consolidation, suggesting pneumonia, associated with a small-to-moderate sized left pleural effusion that may have some loculation inferiorly (Figure 3).
Figure 3. Axial unenhanced thoracic CT shows lingular (arrowheads) and left lower lobe (arrows) consolidation associated with a small left pleural effusion (*), with minimal nodular opacity in the right upper lobe and mild opacities in the right middle and right lower lobes. No evidence of right pleural effusion is seen. The unenhanced thoracic CT findings confirm the chest radiographic findings.
No evidence of pericardial effusion is seen, and the attenuation of the aortic wall is within normal limits. The mild, regular hyperattenuation of both the ascending and descending thoracic aortic wall is the result of anemia, not intramural hematoma- no evidence of acute aortic syndrome is present. The left mainstem bronchus is patent; no evidence of obstructing lesion is seen. Pneumomediastinum is not present.
Clinical course: The patient was noted to have an increasingly altered level of consciousness, manifest as worsening lethargy and confusion, associated with intermittent tachycardia (heart rate ≈ 120’s) and fever. Due to the inability to control the airway and worsening repository status manifested as worsening hypoxia and increasingly labored breathing, the patient was intubated. Blood cultures and enhanced brain CT were performed. Lower extremity venous ultrasound showed no evidence of deep venous thrombosis. Brain CT showed a poorly defined right parietal low attenuation focus raising the possibility of an acute infarct or possibility encephalitis. Repeat frontal chest radiography (Figure 4) was performed.
Figure 4. Repeat frontal chest radiography.
Which of the following statements regarding the chest radiograph is most accurate? (Click on the correct answer to proceed to the 4th of 7 panels)