Presentation
Referred from pulmonologist for chest radiograph to follow up his COPD
Patient Data
Can you make the finding even though no history to the finding was provided?
PA and lateral chest radiographs are submitted. There is an AICD overlying the left chest with lead
tip at the right ventricular apex, that has been placed for unresectable cardiac fibroma. There are 2 surgical clips overlying the left axilla.
The cardiopericardial silhouette and mediastinum are within normal limits. There is a calcified opacity overlying the mid left heart border consistent with known calcified cardiac fibroma as per chart review.
Low dose CT from lung cancer screening
Chest incidentals: Left-sided defibrillator lead terminates in the right ventricular apex. Calcification along the superior left cardiac margin, presumably representing known unresectable cardiac tumor.
This CT chest was from low dose CT for lung cancer screening.
Case Discussion
The surgery or biopsy was performed in a different hospital and we do not have access to the same. The chart mentions unresectable cardiac fibroma. The ICD was also placed elsewhere for unresectable calcified cardiac fibroma causing arrhythmia.
When one sees an ICD on chest radiograph a radiologist should have a thought process as to why it was placed.
One should be curious to see the chart even though we were given COPD as ordering history.
There is a low dose CT chest in PACS to see this in correlation.
https://cortex.acr.org/CiP/Pages/CaseView?Info=+35fRWXorFyXb7QYX9eE7g=%3d
This link to ACR case in point has a nice case discussion.
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