Radiologist HRCT Template

**Date of scan:** 01/Nov/24 **Clinical information:** * 58-year-old male with progressive dyspnoea and non-productive cough. * History of occupational asbestos exposure. * Concern for interstitial lung disease or malignancy. **Prior imaging:** * CXR: 15/Mar/23 - showed bilateral lower lobe reticular opacities, stable compared to prior. No prior CT available for comparison. **Technique:** High resolution CT chest technique consists of supine inspiratory imaging, supine expiratory imaging and prone imaging. Supine inspiratory and expiratory imaging were undertaken. Prone imaging was not undertaken. **Findings:** Lung parenchyma findings: Diffuse, fine reticular interstitial thickening is noted throughout both lower lobes, with associated traction bronchiectasis. Subpleural sparing is observed. No honeycombing is definitively identified, but early fibrotic changes are present. Ground-glass opacities are seen predominantly in the posterior basal segments. These findings are abnormal. Airways findings: Mild bronchial wall thickening is present, consistent with chronic inflammation. No significant airway obstruction or bronchomalacia is observed. Findings are abnormal. Inflammation, infection, or malignancy findings: No focal consolidations or pleural effusions are identified to suggest acute infection. There is no evidence of active inflammation. No discrete mass lesion or suspicious nodule suggestive of malignancy is seen within the lung parenchyma. Findings are normal. Lung nodules or mass lesions findings: No lung nodules or mass lesions are identified. Findings are normal. Expiratory imaging and air trapping findings: Expiratory images demonstrate scattered areas of mild mosaic attenuation, predominantly in the lower lobes, consistent with subtle air trapping. Findings are abnormal. Lymph nodes findings: A few non-enlarged mediastinal lymph nodes are present, the largest measuring 8 mm in the subcarinal region (level 7). No suspicious hilar or axillary lymphadenopathy. Findings are normal. Pleura and pericardium findings: Bilateral pleural plaques are present along the diaphragmatic surfaces, consistent with prior asbestos exposure. No significant pleural effusion or pericardial effusion. Pleural thickening is present along the right posterior pleura, measuring 3 mm. Findings are abnormal. Bones findings: Degenerative changes are noted in the thoracic spine. No lytic or sclerotic lesions. Findings are normal. Subcutaneous soft tissues findings: Normal subcutaneous soft tissues. Findings are normal. Coronary artery abnormalities findings: Ungated imaging: Moderate calcification of the left anterior descending and right coronary arteries is demonstrated. Findings are abnormal. **Conclusion:** Diffuse interstitial lung disease, highly suspicious for asbestosis, with evidence of early fibrotic changes and mild air trapping. Bilateral pleural plaques are also noted. Moderate coronary artery calcification is present. Incidental moderate coronary artery calcification demonstrated. If the patient has associated symptoms of angina, recommend management as per chest pain guidelines, including cardiology referral if appropriate. If the patient is asymptomatic, routine cardiology referral not required, GP and/or referring clinician to consider reviewing modifiable cardiovascular risk factors and managing as per guidelines for primary prevention.