Correct!
2. The frontal chest radiograph shows fairly diffuse, bilateral, increased opacity
The presentation chest radiograph (Figure 1A) shows fairly diffuse, right-greater-than-left, bilateral increased attenuation, without clear air bronchograms. Note that the pulmonary vessels are visible through the areas of increased attenuation- an appearance often referred to as “ground-glass opacity” (although this term is more commonly applied to increased attenuation at CT that does not obscure the bronchial walls and vessels). Note that this appearance contrasts with consolidation, in which increased lung attenuation obscures the bronchial walls and pulmonary vessels, and is often associated with air bronchograms- no consolidation is evident on the chest radiograph. The mediastinal contours appear normal. Layering pleural effusions can produce a ground-glass appearance at chest radiography, but this situation is typically observed in supine patients, and the patient is in upright position for the chest radiograph in Figure 1A, and no pleural liquid is evident.
The patient’s medications included hydroxurea and diltiazem. She was a non-smoker. Physical examination showed some mild, symmetric lower extremity edema and elevated jugular venous pressure as well as hepatosplenomegaly. The patient’s heart rate varied between 80 and 120, with respirations approaching 20 / minute. Her oxygen saturation on room air was 90%, increasing to 96% on 2 liters oxygen by nasal cannula, but decreasing to 88% with exercise. The patient’s white blood cell count was persistently elevated at 20 – 50 x 109 / L with a neutrophilic predominance and a few immature forms. The platelet count was 189,000 103 / mcL. Her hemoglobin was diminished at 10.4 gm/dL. Other laboratory data abnormalities were noted as well, including sodium and potassium levels of 153 and 5.3 mmol/L, respectively, and creatinine of 1.9 mg/dL. The patient subsequently underwent thoracic CT (Figure 2).
Figure 2. Thoracic CT scan displayed in lung windows.
Which of the following regarding this pulmonary CTA examination is correct? (Click on the correct answer to proceed to the third of five panels)