Diagnosis of Case Study #3

Computed Tomography (CT) of the Thorax:
A spiral acquisition was obtained after administration iodinated contrast material. There is an ill-defined soft tissue mass within the left axillary region. The mass has irregular margins and displaces the axillary artery medially. Mediastinal lymphadenopathy is also noted. Upon examination of the pulmonary parenchyma, multiple pulmonary nodules are identified, measuring between a few mm to 6 mm in diameter.

Impression:
The CT findings are compatible with left axillary mass with cranial mediatinal lymphadenopathy. The pulmonary nodules represent pulmonary metastases.

Comments:
Spiral CT scanning permits rapid acquisition of a volume of tissue with collection of data over the entire anatomic region. This information can then produce high quality 2D images. Compared to Conventional CT where the images are obtained slice by slice, with Spiral CT, the patient, on the table is advanced through the gantry as the CT tube and detectors continuously rotate around the patient. The spiral movement of the Xray tube around the patient simulates the threads of a screw.

The rapid acquisition of images is helpful in reducing the patient's respiratory movement and can be applied to lung imaging, to determine the location of critical vessels to abdominal masses, to assess the location of adrenal masses in association with the caudal vena cava and aorta, IVP for ectopic ureters, and to angiographic procedures (CT angiography). With CT angiography, IV administration of contrast media, with critical timing, will allow the maximum opacification without need for selective catheterization.

Contrast resolution is greatly enhanced with computed tomography allowing visualization of small pulmonary nodules that would not have been otherwise visible on conventional thoracic radiographs.

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