Ct Followup Meet

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    01-02-2012 to 29-02-2012

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    Case 1 R. F. M C S; 83 years; male,

    Clinical Details:

    Old IWMI Breathlessness x 2 years; aggravated since few months

    X ray: Tracheal compression by goitre - ? R/cHaemorrhage.

    Requisition for CECT Chest & Neck

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    Tracheal deviation toleft.

    Minimal widening ofsuperiormediastinum.

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    Multiple areas of central bronchiectases in bilateral lower lobes.

    Rest of the lung werenormal.

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    Enlarged thyroid , heterogenous lesions with central areas of hypodensity,

    scattered macrocalcifications, retrosternal extension & Mass effect.

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    Mass effect:-Compression & lateral displacementof trachea & esophagus to the left.Compression of pre vertebral space.Lateral displacement of the leftcarotid space.

    Compression with proximaldilatation of right internal jugularvein.Fat planes with adjacent structures:mantained.

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    FINAL DIAGNOSIS

    Multinodular goitre with retrosternal extension of the

    right side. Multiple areas of central bronchiectases in bilateral

    lower lobes.

    FOLLOW UP

    Patient not willing for surgery in view of co-morbidities.

    Suggested 3 monthly review by treating physician.

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    Case 2 Mrs. A V, 61 years, Female

    Clinical details:-

    k/c/o Ca Left Breast Infiltrating duct carcinoma, BloomRichardson grade II.

    Post mastectomy, post chemotherapy & radiotherapy x5 years back.

    Presenting complaint: Right shoulder pain x 1 month.

    Mass over anterior aspect of chest.

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    Widening of superiormediastinum.Discontinuity of thehead of humerus on theright side.

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    Multiple well defined roundedsoft tissue density lesion inlingular segment & basal

    segment of right lower lobe.

    Pleural thickening inleft apical region.

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    Lytic destructive & expansile lesion of sterum in its entireextent.Adjacent soft tissue extension into the anterior mediastinum &into the intramuscular & subcutaneous plain of anterior chestwall in the midline & right parasagittal location.

    Soft tissue show lobulated apprarance & heterogenous postcontrast enhancement, probably representing central necrosis.

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    Pretracheal & Preaortic lymphnodes with necrosis # humerus

    Left post mastectomy splenunculi Adrenal Liver : Normal

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    FINAL DIAGNOSIS

    Local recurrence of disease with lung , bone & nodal

    metastases. Pathological fracture of right humeral head.

    LOST FOLLOW UP

    Patient has not reported back to treating doctor at

    Caritas Hospital, KTM, till date.

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    Case 3 Mr. P, 30 yr, male.

    H/o RTA.

    FAST: Free fluid with internal echoes- ? Hemoperitoneum.

    Left sided pleural effusion.

    Requisition: CT Brain & CT abdomen.

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    SDH & SAH &Pneumocephalus

    Extensive facial # withhemosinus

    Parasymphyseal # ofmandible.

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    Grade 3 laceration ofliver.

    Peri hepatic,subhepatic,perisplenic

    & pelvic fluid.Compressed IVC - 2to shock.No PE.

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    FINAL DIAGNOSIS Extraaxial haemorrhage, pneumocephalus with extensive

    facial # & hemosinus.

    Parasymphyseal # of mandible. Grade 3 laceration of liver. Moderate hemoperitoneum.

    FOLLOW UP Burr hole drainage of SDH. Maxillo mandibular fixation with interdental wiring &

    ORIF of maxilla. Conservative management for liver trauma. Patient doing well, tide over critical stage, discharged.

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    Case 4 Mrs.PD, 51yrs old, Female.

    Clinical details:- B/L pedal edema

    3 episodes of syncopal attack.

    JVP CCF.

    ECHO RV Dysfunction, PAH.

    CDS Leg B/L Posterior tibial vein thrombosis.

    X ray: PE Right. ? Pulmonary embolism.

    Requistion CECT Pulmonary Angio

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    Wedge shaped opacity in right lower zone.

    Pulmonary arteries up to segmental branchesshow intraluminal non enhancing areas.Crescent like appearance.

    Doughnut sign + wedge shaped opacity showingcontrast enhancement.

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    Bands

    Wedges shape soft tissue opacities B/L basallobes

    Passive collapse medial basalsegt.

    Aorta : PA >1:1

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    FINAL DIAGNOSIS

    Chronic Thrombo Embolism; however, Few segmental pulmonary arteries show central non enhancing

    areas with peripheral contrast pooling right lower lobe,

    possibility of an acute thrombotic episode cannot be completelyexcluded. FOLLOW UP

    Was put on iv heparin. Deferred admission to CCU, thus thrombolysis with streptokinase

    could not be done. D-dimer not sent, due to poor economic status of patient. Condition improved, discharged & returned to hometown.

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    Case 5 Mrs.S, 70 yrs old, female.

    Clinical details:-

    k/c/o Carcinoma breast 1987. Chest wall recurrence 2005.

    U/L Pleural effusion , pleural tap : twice ve, empiricallystarted on AKT.

    Now; On AKT, r/c PE.

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    Right side pleural

    effusion.Collapse of middle lobe&Passive collapse of lowerlobe.Mediastinal shift to left

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    Subsegmentalcollapse oflingula.

    Pericardialthickenin gwithcalcification

    Pleural calcification Lytic area in body of sternum.

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    CholelithiasisBilateralextrarenal pelvis

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    FINAL DIAGNOSIS

    Moderate PE Right right middle lobe collapse, passivecollapse of right lower lobe, mediastinal shift to left & sub

    segmental collapse of lingula. B/L pleural calcification & lytic lesion with sclerotic margin

    of sternum post RT & Post op change.

    FOLLOW UP

    Pleural tap: ve for malignant cells. During hospital stay, developed hypotension.

    TB PCR : -ve.

    Referred to amrita for pleural biopsy: lost follow up.

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    Case 6 Mrs.K A, 70 year, female.

    Clinical details:-

    Anaemia & weight loss o/e: NAD

    USG: Multiple hypodense lesions of liver s/o livermetastases.

    Requisition for CECT Abdomen: r/o disseminatedmalignancy.

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    Enlarged heterogenous liver ,multiple peripherally enhancing lesions.

    Moderate ascites

    Peripherally enhancing lesion inhead & tail of pancreas.

    Loss of fat plane with spleen & stomach

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    Thickened enhancing GBwall

    ? Pulmonary nodule Lytic lesion in L3 vertebra

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    FINAL DIAGNOSIS

    Hepatic metastases with probable metastases in bone& lung. Lesion in Pancreas of gall bladder mayrepresent primary lesion.

    FOLLOW UP

    CT guided biopsy from liver: Moderately differentiated

    metastases from adenocarcinoma. Took 2 cycles of chemotherapy. Expired on 06.03.12.

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    Case 7 Mr. G T K, 62 year, male

    Clinical details:-

    k/c/o restrictive lung disease, COPD, Polycythaemia,Sarcoidosis.

    h/o significant weight loss & loss of appetite

    P/A: hard liver

    USG: 17 cms liver, multiple focal lesions -? Metastases/ ?multifocal multicentric hepatoma

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    hepatomegaly

    Multiple well defined hypodensenodules

    Peritoneal nodules Adrenal lesion

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    Apical & paraseptalemphysematous changes.Multiple confluent & discretesoft tissue density nodules left

    lower lobe.Aslo, bilateral pleuralthickening.Confluent nodules showedenhancement.

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    FINAL DIAGNOSIS

    Peripheral bronchogenic carcinoma with rest of thelesions as distant metastases.

    All lesions may be considered as metastases with anunknown primary.

    FOLLOW UP

    CT guided biopsy from lung lesion: SMALL CELLCARCINOMA.

    Patient chose to take palliative care at local hospital.

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    Case 8 Mr. C M M, 75 years, male.

    Clinical details:-

    k/c/o COPD, chronic smoker. o/e B/L Rhonci, + Crepitation.

    X ray: Right lobulated mass in upper zone,

    ? Soft tissue lesion in the left lower

    zone.Provisional :? Malignancy/ ?consolidation.

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    Multilobulated heterogenous moderately enhancing soft tissue lesion

    , anterior segment, upper lobe. Destruction of sternal surface of 5th &6th ribs & lateral surface body & manubrium of sternum.

    Air spaceopacity in theapicoposteriorsegment of left

    patchy upperlobe - ?Consolidativechange.

    Architectural

    distortionof bothlungs

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    FINAL DIAGNOSIS

    Peripheral bronchogenic carcinoma with local spreadand bone metastasis.

    FOLLOW UP

    CT guided biopsy report: Squamous cell Carcinoma.

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    Case 9 Dr.T D H, 42 year, Male.

    Clinical Details:-

    h/o on and off fever & excessive lethargy. 1 episode of hemoptysis.

    Chest x ray: Cavitatory lesion in right mid zone.

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    Well defined immobile air filled cavity with enhancing wall (4mm), RLL apicalsegt.

    Non enhancin fluid within, ?clot/secretn.Few discrete bronchiectases.

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    FINAL DIAGNOSIS

    Right lower lobe apical segment cavity with

    - ? Clot/? Secretions: Features suggestive of infectiveprocess tuberculosis with cavity.

    - In view of negative TB- PCR, other possibility ofcavitating pneumonia may also be considered.

    - Bronchiectases & centrilobular emphysema.- FOLLOW UP

    - Patient started on AKT, condition remains status quo.

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