47-year-old man with shortness of breath and concern for interstitial lung disease. LUNGS AND PLEURA: Examination is limited by significant motion artifact and the lower lung volumes. The upper lung zones are relatively opaque with areas of focal low attenuation. There is also significant pulmonary vascular redistribution and pulmonary arterial hypertension. Mild peribronchial thickening is also seen in the upper lung zones. Focal areas of groundglass opacity are seen in the periphery of the lungs in the lower lobes and appear to be in direct relation with pulmonary vessels.Multiple micronodules, the largest of which measures 3 mm, and granulomas most suggestive of prior granulomatous disease, but too small to characterize.MEDIASTINUM AND HILA: Severe cardiomegaly. Minimal pericardial fluid. Multiple mediastinal lymph nodes the largest of which measures 11x 20 mm, (image 35 of series 5). Proximal esophagus is patulous.Main pulmonary arteries enlarged measuring 3.8-cm, image 36, series 5, compatible with pulmonary arterial hypertension. The serpiginous posterior mediastinal and esophageal vessels suggesting lower esophageal varices.CHEST WALL: Unilateral subcutaneous edema and fluid in the left flank. Bullet fragment adjacent to the left scapula. Borderline right axillary lymph node measures 12 mm, (image 35 series 5). Collateral vasculature noted in the chest wall bilaterally.UPPER ABDOMEN: Evaluation of solid organ pathology and lymphadenopathy is limited secondary to lack of intravenous contrast and motion artifact. Marked amount of intra-abdominal ascites. Multiple surgical clips in left upper quadrant adjacent to atrophic appearing spleen. The spleen is abnormal in shape and has areas of low attenuation which are nonspecific and could represent cysts or infarct.
1. Limited examination without specific findings of interstitial lung disease as clinically questioned.2. Pulmonary arterial hypertension with findings in the lungs that could reflect sequela of PAH/chronic thromboembolic disease. The presence of an enlarged left atrium and upper lobe vascular redistribution weighs against the diagnosis of pulmonary venoocclusive disease. Correlation with nuclear scintigraphy may be of use.3. Findings in the abdomen and left flank are suggestive of cirrhosis with portal hypertension though not conclusive. Correlate with LFTs.