HRCT CHEST REPORTS:

 

Large area of consolidation with air bronchograms with near complete involvement of the right lower lobe. -Likely infectivbe etiology.

Subsegmental atelectasis is noted in the right middle lobe.

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Centrilobular, paraseptal and panacinar emphysematous changes noted predominantly involving the bilateral upper lobes (more so in the apical segments) and left lower lobe, along with emphysematous bullae in the right apical region.

Few fibroatelectatic bands are noted in the apical segment of right upper lobe.

Few fibronodular opacities are noted involving the left lower lobe.

Mild cystic and cylindrical bronchiectasis noted involving the right upper, middle lobes, left upper lobe , Lingula and lower lobe.

Tiny nodular opacities are noted predominantly involving the right middle lobe, lower lobe and the left lower lobe.

Few thin walled small cysts are noted predominantly involving the left upper lobe and bilateral lower lobes

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Normal aeration of all the bronchovascular segments of both the lungs seen with normal bronchovascular markings.
No focal lesions seen.
No evidence of interstitial lung disease is seen.
MEDIASTINUM:
Pulmonary arteries are normal. Atherosclerotic changes in the form of calcified plaques noted in the aorta.
Few small volume pre and paratracheal, subcarinal and prevascular level lymph nodes noted.
Few small volume pre and paratracheal, subcarinal and prevascular level lymph nodes noted. The trachea, carina and the major bronchi show no pathology. Sliding hiatus hernia noted.
PLEURA AND CHEST WALL:
No pleural pathology made out.
Scoliotic deformity of the dorsal spine. Old healed rib fractures noted on the lateral aspect of the rib cage extending from 3^rd to 8^th ribs on right side. Decreased bone density with degenerative changes in the form of multilevel anterior marginal osteophytes noted.
Large bullae are noted in bilateral lungs in all lobes, largest at the upper and lower lobes. The largest bulla is in the right lower lobe measuring 9.2 x 5.4 cms .
Multiple enlarged mediastinal lymph nodes, largest measuring 10 mm in precarinal location.
PLEURA AND CHEST WALL:
No pleural effusion.
Centrilobular paraseptal and panacinar emphysema. Large bullae in bilateral lungs in all lobes.
Normal aeration of all the bronchovascular segments of both the lungs seen with normal bronchovascular markings.
No focal lesions seen.
No evidence of interstitial lung disease is seen.
The aorta and pulmonary arteries are normal.
No mediastinal lymphadenopathy seen.
The trachea, carina and the major bronchi show no pathology.
No pleural pathology made out.
The dorsal spine, rib cage and the surrounding soft tissues appear normal.
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- features likely suggestive of - Sequelae of old infectious aetiology

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Fibroatelectatic changes with traction bronchiectasis noted involving the anterior segment of right upper lobe.

Mild traction bronchiectasis is also noted in the right middle lobe and superior basal segment of left lower lobe.

Mosaic attenuation noted involving the bilateral lungs, more apparent in the bilateral lower lobes

Diffuse irregular interlobular interstitial thickening and subpleural reticulation noted involving the bilateral lungs, predominantly in the bilateral lower lobes.

Mild subpleural honeycombing is noted in the superior basal segment of the right lower lobe.

IMPRESSION :

Above-mentioned features are suggestive of pulmonary fibrosis - ? UIP .

Compared with previous HRCT (dated 31/05/2023) , no significant interval change noted.

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Patchy areas of ground glassing surrounded by a crescenteric consolidation noted involving the anterior segment of right upper lobe, anterior segment of left upper lobe , left lingula and lateral segment of left lower lobe.

Coalescing patchy consolidation noted involving the right middle lobe.

Few nodular opacities noted involving the bilateral upper and lower lobes, with a nodule showing cavitation in the right lower lobe posterior basal segment

Large patchy area of ground-glass opacities also noted involving the right lower lobe.

Rest of the bilateral lung parenchyma appears normal.

IMPRESSION :

Above mentioned features are suggestive of infective aetiology ( ? fungal origin).

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FINDINGS:

LUNGS:

Paraseptal tiny cystic spaces with surrounding fibrotic changes noted in right apical segment. Pleuroparenchymal band noted in the posterior segment of right upper lobe. Mosaiac attenuation noted in left lower lobe. Subsegmental atelectasis noted in the medial part of posterior segment of left lower lobe.

IMPRESSION:

• Fibrotic changes in apical and posterior segment of right upper lobe.

• Mosaiac attenuation in left lower lobe- Likely small airway disease.

• Few small volume mediastinal lymadenopathy.

• Hiatus hernia.

• For clinical correlation please.

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Irregular walled cavitatory lesion noted involving the left upper lobe apicposterior segment with few adjacent nodules.

Multiple soft tissue density nodules scattered predominantly in the right upper lobe, right middle lobe, left upper and lower lobes and left lingula with some showing tree in bud appearance.

Subsegmental collapse consolidation noted involving the left lingula and anteromedial segment of left lower lobe.

Patchy areas of ground-glass opacities are also noted involving the anteromedial segment of left lower lobe.

IMPRESSION :

Above mentioned features are suggestive of - Infective aetiology (? Koch's).

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LUNGS:

Centrilobular and paraseptal emphysematous changes are noted in bilateral lungs in all lobes.

Panacinar emphysematous changes are noted in the right lower lobe.

Fibrobronchiectatic changes are noted replacing most of the right upper lobe, with few calcific densities within.

Consolidations and nodules are noted in the left upper lobe.

Multiple nodules and consolidations are also noted in the right lower lobe and right middle lobe.

Multiple nodules, mostly calcified are noted in the left lower lobe.

MEDIASTINUM:

There is mild shift of mediastinum to the right.

Heart and great vessels show normal contrast enhancement.

Prominent central pulmonary arteries.

Atherosclerotic changes in arch and descending thoracic aorta.

Degenerative changes in the spine.

IMPRESSION:

Fibrobronchiectatic changes have replaced most of right upper lobe.

Multiple small consolidations, multiple nodules (some are calcified) in bilateral lungs.

Mediastinal lymphadenopathy.

• likely infective etiology.

Suggested correlation with previous imaging/clinical corelation/follow up imaging.

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LUNGS:

MEDIASTINUM:

PLEURA AND CHEST WALL:

Degenerative changes noted in the visualized spine

Visualised sections of abdomen:

Mild circumferential wall thickening noted in the pylorus of stomach- For endoscopy correlation

IMPRESSION:

• NO LUNG PARENCHYMAL MASS OR CONSOLIDATION.

• NO MEDIASTINAL LYMPHADENOPATHY.

• NO PLEURAL OR PERICARDIAL EFFUSION.

Fibrotic lesions with tiny cystic foci are noted in bilateral lung apices.

Mild ground-glass attenuation areas are noted in bilateral upper lobes and right middle lobe.

Few small mediastinal lymph nodes.

Trachea is midline normal.

Heart and great vessels are normal in attenuation.

No pleural effusion.

Degenerative changes in the spine.

Few calcific foci are noted on the liver surface.

Few calcific nodules are noted at the porta - likely calcified lymph nodes.

 IMPRESSION :

Fibrotic lesions with tiny cystic foci in bilateral lung apices.

Mild ground-glass attenuation areas in bilateral upper lobes and right middle lobe - infective etiology/other.

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