Presentation
Dyspnea, cough, bilateral lower limb edema.
Patient Data
Diffuse interstitial pulmonary process in the form of diffuse patchy ground-glass attenuation and reticular opacities affecting both lungs with posterior and lower lobe predominance. Lung architectural distortion due to patchy areas of intralobular septal thickening resulting in reticular pattern. Dilated and distorted centrilobular bronchioles suggestive of traction bronchiolectasis. Multiple subpleural lines visible. Patchy areas of concentric macrocystic honeycombing. Multiple reactive mediastinal lymph nodes.
Markedly enlarged right atrium and right ventricle of the heart; increased RT to LT ventricular ratio 1. Deviated interventricular septum towards the left side. Moderate pericardial effusion measuring 1.8 cm in maximum thickness. Prominent pulmonary trunk (3 cm) with mildly dilated pulmonary arteries. Markedly dilated hepatic veins.
Enlarged liver with diffuse decreased matrix attenuation associated with markedly enlarged hepatic veins. Marked hydrops of the gall bladder. Small volume ascites in Morrison’s pouch, perihepatic and perisplenic regions.Mild diffuse truncal subcutaneous edema. Diffuse mesenteric congestion. Left renal middle calyceal stone measuring 7mm.
Case Discussion
Features are suggestive of interstitial pulmonary fibrosis with secondary cor-pulmonale and right sided heart failure with consequent passive hepatic congestion.
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