CT Thorax Report

History

The patient presents with a complaint of cough for one week, which has been intermittent. The patient underwent a bronchodilator trial but experienced no symptom relief.

Technique

High-Resolution Computed Tomography (HRCT) of the thorax was performed.

Findings

The key findings include:

• Lung Parenchyma:
  • Minimal ground-glass opacities in the dependent portion of the left lower lobe.
  • Few subpleural reticulations in the lateral segment of the right middle lobe and the middle and anterior segments of the right lower lobe.
  • Bilateral tubular bronchiectasis, more pronounced in the lower lobes.
• Mediastinum:
  • Sliding hernia of the stomach into the mediastinum through a gap of approximately 5.2 cm.
  • The gastroesophageal junction is elevated, approximately 8.4 cm above the diaphragm.
• Other Findings:
  • Myelotic and coronary calcification.
  • Few subcentimeter lymph nodes in the mediastinum, all less than 10 mm in short axis diameter.
  • Increased kyphosis of the dorsal spine with significant degenerative changes and bridging osteophytes.
  • A small exophytic cortical cyst in the mid pole region of the left kidney.

Impression and Recommendation

Based on the imaging findings and clinical history, the patient's presentation is most consistent with a sliding hiatal hernia, which likely explains the mediastinal widening observed on the chest X-ray. The hernia and associated findings such as bronchiectasis and ground-glass opacities suggest a complex clinical picture that may involve gastrointestinal and respiratory components.

Differential Diagnosis

Single Most Likely Diagnosis

• Gastroesophageal Reflux Disease (GERD): The presence of a sliding hiatal hernia and the patient's symptoms of cough, which can be exacerbated by reflux, make GERD a highly plausible diagnosis. The hernia can lead to reflux, which in turn can cause respiratory symptoms.

Other Likely Diagnoses

• Chronic Bronchitis: The bilateral tubular bronchiectasis and the patient's cough symptom could suggest chronic bronchitis, especially in the context of possible aspiration or reflux.
• Aspiration Pneumonia: Given the hiatal hernia and potential for reflux, aspiration pneumonia is a possible diagnosis, especially if the patient has had episodes of aspiration.

Do Not Miss Diagnoses

• Lung Cancer: Although less likely given the patient's age is not provided and the lack of a significant smoking history in the provided information, lung cancer can present with similar findings, including bronchiectasis and ground-glass opacities. It is crucial to follow up on any suspicious findings.
• Pulmonary Embolism: While the current imaging does not directly suggest pulmonary embolism, it is a critical diagnosis to consider in patients with respiratory symptoms, as it can be life-threatening.

Rare Diagnoses

• Eosinophilic Pneumonia: This condition can present with ground-glass opacities and could be considered if other diagnoses are ruled out, especially in the context of atypical respiratory symptoms.
• Cystic Fibrosis: Although typically diagnosed at a younger age, cystic fibrosis can present with bronchiectasis. It would be an unlikely diagnosis without additional supporting evidence, such as recurrent infections or failure to thrive in younger patients.

Each of these diagnoses is considered based on the provided imaging findings and clinical history, with an emphasis on accuracy and relevance to the patient's presentation. Further diagnostic testing or clinical correlation may be necessary to confirm the diagnosis.