30 year old female with Cushing's disease. Now with bilateral ribs/chest pain. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Heterogeneous enlargement of the right thyroid lobe with mixed calcific and low densities. No mediastinal or hilar adenopathy.CHEST WALL: Fractures of the left 9th and 10th ribs posteriorly, raising the question of direct trauma. Small amount of callus formation surrounding the 10th rib fracture suggests subacute injury.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Questionable enhancing small nodule in the left adrenal gland (series 3 image 87), however, this is equivocal.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Abundant amount of retroperitoneal fat deposition, compatible with Cushing's.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Presumed VP shunt catheter tubing courses down the anterior soft tissues of the chest/abdomen and courses anterolaterally in the left lower abdomen.
1) Fractures of left 9th and 10th ribs posteriorly, raising the question of direct trauma.2) Heterogeneously enlarged right thyroid lobe.3) Questionable small enhancing left adrenal nodule.4) No intrapulmonary abnormalities.