CHEST 1V
Clinical History: seizure

A single image of the chest is presented without comparison. A 5.2 cm x 4.4 cm ovoid, circumscribed mass-like focus projects over the right cardiac border in this single image. No lateral projection is available. No effusion is present. No other mass or infiltrate is noted. Cardiac and mediastinal silhouettes are within normal limits. Bones and soft tissues are unremarkable.

IMPRESSION:

Ovoid mass-like density projecting over the right cardiac border as described above. Mediastinal/hilar mass is suspected and both PA and lateral images of the chest are recommended along with CT of the chest for adequate evaluation (unusual presentation of pseudotumor).

CT HEAD WO CONTRAST
Findings:

Exam ordered on an emergent basis and results faxed to the ER 8/02/05 6:55 pm at time of interpretation.

Multiple computed axial tomograms were obtained through the brain without the use of contrast.

No evidence of hemorrhage or infarction. No mass effect or midline shift. The ventricles are normal in size, shape and position. The visualized paranasal sinuses are free of disease. No other significant findings.

IMPRESSION:

Unremarkable noncontrasted CT scan of the brain.

CT THORAX W/CONTRAST
Findings:

Exam ordered on an emergent basis and results faxed to the ER 8/02/05 8:10 pm at time of interpretation.

Multiple computerized axial tomograms were obtained through the chest following the administration of IV contrast. 100 cc Optiray 320 were injected intravenously.

Exam is compared to chest x-ray from earlier the same day which does in fact show a large right hilar mass.

Corresponding to the abnormal chest x-ray is a lobulated heterogeneous 6.3 x 4.6 cm right hilar mass. Areas of low density are consistent with areas of necrosis. The mass surrounds and markedly narrows the right descending pulmonary artery. No other mass lesions are identified. No left hilar masses and no mediastinal lymphadenopathy. The lung fields are clear of suspicious findings.

Atherosclerotic change of the thoracic aorta noted without aneurysm. No osseous lesions are identified. No significant findings in the visualized upper abdomen. The visualized bilateral adrenal glands appear normal. Gallbladder has been removed. No hepatic lesions are identified involving the visualized portion of the liver.

IMPRESSION:

Corresponding to the abnormal chest x-ray finding is a 6.3 x 4.6 cm lobulated heterogeneous right hilar mass most consistent with neoplasm. Again, the mass surrounds and markedly narrows the proximal aspect of the right descending pulmonary artery. Further evaluation is needed.

Lab Results

Comp Metabolic Panel
glucose, blood	H 144
blood urea nitrogen	11
creatinine, serum	0.8
sodium, serum	139
potassium, serum	3.6
chloride, serum	105
carbon dioxide	24
calcium, serum	9.1
total protein, serum	H 8.5
albumin, serum	4.1
phosphatase, alkal	119
ast (sgot)	23.
alt (sgpt)	17
bilirubin, total	<0.3
anion gap (calc)	13.6

CBC Automated
wbc	7.59
rbc	4.77
hemoglobin	13.7
hematocrit	40.3
mch	28.7
mcv	84.5
mchc	34.0
platelet	275
mpv	H 10.7
rdw-cv	13.5
rdw-sd	42.1
nrbc (percent)	0.0
nrbc (absolute)	0.00