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This is a case of a 23-year-old female patient who was admitted to the ER

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with shortness of breath and a history of asthma.

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PA and lateral views of the chest were submitted.

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And here we see, again,

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going through our standard views, looking at the lungs. In the left lung,

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that looks like here in the lingular area, there's a hazy opacity that is seen here,

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but there's no other consolidation that we see.

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There's no pneumothorax.

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The costophrenic angles are bilaterally appropriately open.

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The right lung is clear. In terms

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of the mediastinum and the heart midline structures, those look normal.

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Looking below the diaphragm, bones, and soft tissues, we look like we're in good shape.

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So on the lateral view, again, we can see that there may be some

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scattered opacities here in the lower lungs.

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The area in the left that we saw, that was

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around the lingula, don't see anything here anteriorly, specifically.

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So it may be certainly here posteriorly.

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We can review the spine and the sternal

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area, as well as the retrosternal area, and that looks fine.

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So coming back to the frontal view,

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we have a patient with asthma who has an opacity here around the lingula,

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or at least the left mid lung zone or the lower lung zone,

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doesn't really correlate to the lingula on the lateral view.

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And it may be that, again, the CT is helpful for further evaluation.

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One thing we'll say here,

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in a patient who's asthmatic, we might expect for there to be hyperinflation.

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This patient does not look hyperinflated.

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Although, we're given a history of asthma.

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So this may not necessarily look like a typical asthma patient.

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And then the CT may be helpful for further evaluation of what's going on.

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So with this opacity here, this could be any number of things related

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to asthma or things that are related to infection.

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And perhaps the infection is triggering what feels like an asthmatic attack.

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So we recommended a CT here, and let's take

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a look to see what else we were able to glean.

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So, just moving through the lung windows

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in the contrast enhanced axial CT, we see scattered ground glass opacities.

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But we're also noticing that there is bronchial thickening seen here.

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We see that bilaterally, it looks like it's involving the lower lobes.

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We see how thick the bronchioles are there.

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Again, scattered ground glass opacity.

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And perhaps this was that area that was correlating to the lingula,

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but is really in the left lower lobe that's seen posteriorly there.

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But we're seeing similar ground glass and consolidated opacities in the right

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middle lobe, in the left upper lobe, in the right upper lobe as well.

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And again, we see really nicely

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demonstrated how thick some of these bronchioles are.

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So if we blow them up, and again see how thick they are.

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You see them in obliquity.

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Let me find a good example.

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Again, you're seeing how thick they are.

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Let's zoom this down a little bit better,

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so you can see again how thick some of these airways are.

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Thickening here, thickening here, so there's diffuse airway thickening.

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And certainly in an asthmatic, you do have one of the hallmarks is bronchoconstriction,

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and you get thickening of those airways, small airways disease,

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and you're getting some of this ground glass opacity and consolidation that's

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taking place here. Suggesting that there's something a little bit more going on,

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and this may be a patient who's got small

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airways disease and whether or not it's just asthma or part of an inflammatory

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bronchiolitis picture with ground glass opacities, as well as airway thickening.

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In a patient with a history of asthma, that's what we're seeing.

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So if we just kind of round things out,

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we don't see pleural effusions, we don't see any evidence of pneumothorax.

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I don't see any mass lesions, any nodules.

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But certainly, small airways disease with airspace

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ground glass opacification.

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We did give contrast,

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so just to run through that really quickly to make sure that we're not missing anything.

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So the thyroid looks normal. Great vessels, some of which are obscured.

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Aorta looks fine.

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All right, the takeoffs.

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So we get quite a bit of the takeoffs here.

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So we're seeing the celiac branch, the SMA branch, the renals

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we're seeing, and everything looks patent.

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There's a lot of motion underneath the diaphragm and the solid abdominal

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organs, but I don't see anything that looks abnormal or concerning there.

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Coming back up, looking at the pulmonary arteries,

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I don't see any filling defects that would suggest a pulmonary embolism.

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The main pulmonary artery caliber is normal.

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One more time, take a look at the soft tissues.

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Don't see any aggressive or concerning lesions.

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And we'll change over to make sure that our bones look fine.

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So now that we have our bone windows open,

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we'll just make sure there's nothing that we're missing, nothing that's concerning.

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And I don't see any aggressive osseous lesions, so that's good.

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We'll pull these over in the coronals, as well.

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Better opportunity to look at the vertebral body heights,

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to look at the alignment, look at the elements, look at the sternum.

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All right, everything looks good here.

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So, as we begin to summarize and put

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everything together, this is a patient who's got a history

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of asthma, who demonstrates small airway disease with evidence of ground glass

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opacities, that some of those opacities are becoming more nodular in appearance.

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So this is an asthmatic with small airways disease, bronchiolitis.

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Again, the CT gives a lot more information than the radiograph was able to give.

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And so, again, when you are given information

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that's helpful to kind of say, hey, well, we're not getting the full extent

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of what's happening here, CT is certainly a problem-solving tool

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moving from radiograph. So, keep that in mind as you're looking

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at opportunities for appropriately utilizing higher order imaging like CT.