69-year-old male with hypertension, diabetes, and esophageal carcinoma, transhiatal esophagectomy Pulmonary Artery: Technically good study. No pulmonary embolism noted to the subsegmental level.MEDIASTINUM AND HILA: There has been interval subxiphoid pericardial drain placement. The drain traverses the distal transverse colon and enters the pericardial sac from a trans-diaphragmatic location (image 32/99). There is a moderately sized pericardial effusion of water density at this time. The right atrium is dilated, a mid LAD stent is present.Again noted are findings compatible with a gastric pull-up containing fluid, air and debris. There is no enteric contrast leak into the mediastinum. Calcified right hilar and mediastinal lymph nodes consistent with prior granulomatous infection.LUNGS AND PLEURA: There is a loculated left pleural effusion with peripheral pleural enhancement and associated internal adhesions suggestive of inflammation. Small associated loculated component within the major fissure on the left. Associated left lower lobe atelectasis. Trace right pleural effusion.Stable biapical pleural scarring with calcification. A reference right-sided, pleural-based nodule has decreased in size measuring 5 x 5 millimeters (22/111). A pulmonary micronodule in the left apical posterior segment is stable.CHEST WALL: No suspicious osseous lesions.UPPER ABDOMEN: An ill-defined area of hypodensity within segment two of the liver (91/111) is present. This is not a dedicated evaluation of the hepatic parenchyma. A metastasis cannot be excluded. Therefore, either a triphasic CT or dedicated hepatic MRI recommended. Multiple bilateral renal cysts.
1. Interval placement of subxiphoid pericardial drain that traverses the distal transverse colon and anterior diaphragm. Findings have been verbally relayed, images have been reviewed with the clinical service at the time of dictation. Moderate pericardial effusion, water density at this time.2. Low-density lesion of segment two hepatic parenchyma raising question of metastasis. Further investigation with either triphasic CT or dedicated hepatic MRI is advised.3. Near complete resolution right pleural effusion. Loculated left pleural effusion with peripheral enhancement and possible internal adhesions.