Neuro_CT_Neck: 18 F, septic shock.

CT NECK: 

 

CLINICAL HISTORY: 18 yo F with septic shock.

 

FINDINGS: 

 

The patient is intubated. The endotracheal tube may be in slightly low position at the carina. However, the carina is not completely visualized.

 

A large right pleural effusion is present at the right lung apex and there is extensive ground-glass opacity with a left upper lobe cavity and area more posteriorly of left peripheral consolidation. Thrombus is seen extending from the right external jugular vein at the lumen of the right internal jugular vein at the C5-6 level. This was present on the previous examination and is less well visualized due to marked streak artifact from the patient's shoulders.

There is infiltration of the right parapharyngeal fat with inflammatory changes but no discrete abscess seen.

Prominent tonsillar tissue is noted bilaterally consistent with history of pharyngitis.

Scattered right neck nodes are noted.

The visualized portions of the brain parenchyma are unremarkable. No bony abnormalities are seen.

An air-fluid level is seen within the sphenoid sinuses and right maxillary sinus possibly due to intubation. The mastoids are clear.

IMPRESSION: 

 

1. Right internal jugular vein thrombus.

2. Evidence of septic emboli within the lung apices and large right pleural effusion. These changes are superimposed on groundglass seen at the apices which could represent superimposed ARDS.

3. Findings consistent with infiltration and infection of the oropharyngeal and right parapharyngeal soft tissues.