Complete Heart Block with Diastolic Heart Failure and Pulmonary Edema Secondary to Enlarging Previously Diagnosed Thrombosed Aneurysm of Sinus of Valsalva in a Patient with History of Autosomal Dominant Polycystic Kidney Disease

Figure 4

CT of the chest without contrast (March 19, 2014). (a) Left lung volume loss was noted in the left lung with underlying atelectatic change. A moderately sized pleural effusion was noted, which contained a second component measuring above that of simple fluid attenuation. These findings might represent an element of a hemorrhagic component. It was possible that this was atelectatic lung adjacent to the pleural effusion. An endotracheal tube was seen with the tip in the distal trachea near the carina. Low attenuation material was present within the left main stem bronchus, causing complete occlusion. Atelectatic changes were present in the right lung base with an early consolidation seen. Numerous nodules are seen throughout the lung fields. Scattered small blebs are noted in the right lung. (b) Heart was showing a heterogeneous mass (blue arrow), again noted to be associated with the left atrium and likely arising from the aortic root which measured 9.5 × 11.1 cm slightly larger in comparison to the MRA of the chest dated June 10, 2008; at that time it measured 8 cm in maximum diameter. There was a mediastinal shift to the left. (c) A calcified right hilar lymph node was noted. A prominent pretracheal lymph node measured 2 × 1.5 cm and could be a combination of 2 adjacent nodes. This was relatively stable. Another adjacent lymph node was measuring 9.7 cm slightly larger. A few other enlarged lymph nodes in the prevascular space were also present. Examination was difficult due to lack of intravenous contrast. (d) Vascular: atherosclerotic calcifications were seen in the aorta and its branches. There was a stable aneurysm of the thoracic aorta measuring 4.4 cm. (e) An enteric tube was seen coursing into the stomach with the tip off the field of view. Multiple splenic cysts were again noted, grossly stable in appearance. One of these cysts contains a calcification. Multiple hepatic cysts were again noted. A small hiatal hernia was seen. A heterogeneous complex cystic mass was again noted in the right hepatic lobe, which measured 9 × 8.3 cm, grossly stable in appearance compared to the most recent MRI from 2012. Multiple renal cysts were seen. Pancreatic calcifications were noted.

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