82-year-old male with CHF, COPD presents with shortness of breath. Recently off Coumadin with elevated d-dimer. PULMONARY ARTERIES: Technically adequate pulmonary embolus examination without evidence of pulmonary embolus.LUNGS AND PLEURA: Multiple punctate calcifications consistent with prior granulomatous disease. Emphysema affects the upper lobes bilaterally. Mild atelectasis at the lung bases bilaterally.MEDIASTINUM AND HILA: Heart size within normal limits. Pacemaker leads terminate in normal position. No pericardial effusion. Atherosclerotic disease affects the visualized aorta. No mediastinal lymphadenopathy.Within the posterolateral aspect of the trachea in a non-dependent position is a 9 mm soft tissue density which is adherent to the right aspect of the tracheal wall, best seen on image 60/115, coronal series. The soft tissue density may represent adherent mucous or debris however further evaluation with bronchoscopy, if clinically warranted, may be considered as an underlying mass cannot be entirely excluded. Emergency room physician Dr. Melinda Graber was notified of results of these findings at 10 a.m.CHEST WALL: Multiple small axillary lymph nodes are not pathologic by size criteria. Minimal gynecomastia may be due to medication or may be physiologic. Pacemaker seen within the subcutaneous tissues of the left chest wall.UPPER ABDOMEN: Multiple punctate calcifications throughout the liver and spleen spleen consistent with prior granulomatous disease. Focal hyperdensity measuring approximately 4 mm adjacent to the right renal hila likely represents vascular calcification. No evidence of hydronephrosis. A nonspecific small adrenal nodule measuring approximately 24 Hounsfield units could be secondary to adenoma. Dedicated adrenal MRI may be considered for further evaluation.
1. No evidence of pulmonary embolus.2. Tracheal soft tissue density may represent adherent mucous or debris, however, further evaluation with bronchoscopy, may be considered as an underlying mass cannot be entirely excluded. Emergency room physician Dr. Melinda Graber was notified of results of these findings at 10 a.m.