Differential Diagnosis for CT Chest Without Contrast
The patient's presentation and imaging findings suggest a range of possible diagnoses. These can be categorized as follows:
Single Most Likely Diagnosis
- Post-surgical complication (e.g., fluid accumulation, atelectasis) due to recent gastrojejunostomy and partial pancreatectomy. This is the most likely diagnosis given the patient's recent surgical history and the presence of a loculated pleural effusion and passive atelectasis without evidence of infection or mass.
Other Likely Diagnoses
- Congestive heart failure: Although there's no pericardial or significant pleural effusion mentioned, the presence of a pleural effusion could be indicative of fluid overload, especially in a post-surgical patient.
- Pulmonary embolism: The patient's shortness of breath and recent surgery increase the risk for pulmonary embolism, although the CT without contrast does not directly diagnose this condition.
- Reactive pleurisy: The loculated pleural effusion could be a reaction to the recent abdominal surgery, especially given the absence of pneumonia or other infections.
Do Not Miss Diagnoses
- Pneumonia: Despite the report stating no infiltrate, pneumonia must be considered, especially with symptoms of shortness of breath and a history that could predispose to aspiration or hospital-acquired pneumonia.
- Hemorrhage: Although the report mentions no hemorrhage, the recent surgical history and the presence of a small amount of blood in the perisplenic collection necessitate consideration of this potentially life-threatening condition.
- Pulmonary embolism (mentioned again for emphasis): Given the high mortality rate if missed, pulmonary embolism must be ruled out, potentially with further imaging like a CT pulmonary angiogram.
Rare Diagnoses
- Chylothorax: This condition, characterized by the accumulation of lymphatic fluid in the pleural space, could be considered given the patient's recent abdominal surgery, although it is less common.
- Pancreaticopleural fistula: A rare complication of pancreatic surgery, where a fistula forms between the pancreas and the pleural space, leading to pleural effusion. This would be an unusual but possible explanation for the loculated pleural effusion.