Clinical Profile:K/C/O ILD , 1 yr back ,c/o fever ,with chills ,c/o cough with expectoration since 15 days ,k/c/o uncontrolled DM ,deranged BSL ,USG s/o fatty liver with hepatomegaly ,cholelithiasis without cholecystitis .
Study reveals,
· Subpleural fibrotic strands with areas of inter/intra lobular septal thickening and honey combing is noted in bilateral lung field predominantly in lingula, apical segment of left lower lobe basal segments of both lower lobes
· Subpleural fibrotic strands with areas of inter/intra lobular septal thickening is noted in and apical and apical segment of right lower lobe, posterior segment of right upper lobe and left upper lobe respectively.
· Patchy ground glass opacities are seen in apical segment of right upper lobe.
· Traction bronchiectatic changes are seen involving basal segments of left lower lobe.
· There is a cavity with surrounding fibrotic changes measuring 2.2x2.0 cm in apical segment of right lower lobe. Another similar cavity measuring 3.3x3.6cm is noted in apical segment of left lower lobe. Soft tissue density measuring 3.2x2.6cm is noted within this cavity , no e/o calcification is noted within this.
· Trachea and major bronchi are normal.
· Multiple enlarged lymphnodes are noted in pre/para tracheal and prevascular, subcarinal region largest measuring 1.2x1.6cm in right paratracheal region.
· Cardiac chambers are normal in size.
· Bovine aortic arch is noted.
· Mediastinal vasculature appears normal.
· Pleural thickening is noted in bilateral basal segments.
· No pleural/pericardial effusion is noted.
· Minimal hyperdense sludge noted in gall bladder.
· Partial thrombosis of hepatic and splenic arteries.
· Visualized bones show degenerative changes in the form of marginal osteophytes .
· Atherosclerotic changes are noted in visualised thoracic aorta in the form of wall calcification
Impression:
· Above F/S/O Interstitial Lung Disease –likely Usual Interstitial Pneumonia.
· Cavity with soft tissue density within as described above likely s/o fungal ball.
· Partial thrombosis of hepatic and splenic arteries.