Correct!
5. All of the above
The chest x-ray shows cardiomegaly, increased density in the left lower lung and probable left pleural effusion. Given the increased size of the heart and the possible pleural effusion and apparent recent development of atrial fibrillation congestive heart failure is a possibility. BNP and NT-proBNP are markers of atrial and ventricular distension due to increased intracardiac pressure. Our patient’s NT-proBNP was markedly elevated at 30,000 pg/ml (normal 10-138 at age >83 years). Echocardiography showed a left ventricular ejection fraction of 38% with right ventricular motion abnormality and right ventricular dysfunction.
To better define the abnormalities on chest x-ray, a CT scan of the thorax was performed (Figure 2).
Figure 2. Representative images from the thoracic CT in lung windows (A-C) and soft tissue windows (D-F). Bottom left: video of thoracic CT scan in lung windows. Bottom right: video of thoracic CT scan in soft tissue windows.
Which of the following should be done next? (Click on the correct answer to be directed to the fourth of six pages)