Age: 85.0
Sex: F
Vaccine: COVID19
Symptoms: Procalcitonin normal, Renal failure, Soft tissue swelling, Thyroid mass, Troponin I increased
Clinical narrative: Unknown lot # as system states COVID-19, mRNA, PF, 30 mcg/0.3 mL dose with an administration code of 213 for unspecified Covid-19 vaccination.  D-dimer 4758 ng/mL , troponin - I 1098 pg/mL, CK MB 8.0 ng/mL, slightly elevated temp, bradycardic, elevated hepatic enzymes, renal failure. BNP 4853, CRP 3.8, procalcitonin negative. CT chest  CLINICAL HISTORY:  Dyspnea.  Elevated D-dimer.  Elevated WBC count.  Abdominal pain.  Elevated liver function test.  COMPARISON:  CT chest 08/14/2021.  Today's chest x-ray.  LABS:  None.  CONTRAST:  Exam performed without IV contrast.  All CT scans at this facility are performed using dose modulation techniques including the following: automated exposure control, adjustment of the mA and/or kV according to patient size, and/or use of iterative reconstruction technique as applicable.  FINDINGS:   CT CHEST:  There is extensive infiltrate seen throughout much of the right lung.  These have shown significant progression compared to prior exam and presumably secondary to pneumonia.  There are mild-to-moderate patchy infiltrates involving the left upper and lower lobes.  There is more focal consolidation near the costophrenic angle in the left lower lobe.  The asymmetry in distribution pattern is atypical for COVID-19.  Other etiologies of pneumonia should be considered.  Aspiration remains a consideration.  Small- to moderate-sized right pleural effusion is new.  Small left pleural effusion which may be somewhat loculated (on prior CT, there was a moderate-to-large left pleural effusion).  Mild-to-moderate cardiomegaly.  Mildly enlarged pretracheal lymph node, image 33, measuring 1.4 cm is new.  This could be reactive in nature.  No axillary adenopathy.  No pericardial effusion.  Calcification of the aortic valve can be associated with aortic valvular stenosis. Nodular and heterogeneous appearance of the thyroid gland.  Mild degenerative changes in the spine.  There is somewhat nonspecific edematous change involving the subcutaneous fat/breast tissue bilaterally.   IMPRESSION:   1.  There are extensive infiltrates throughout the right lung.  Mild-to-moderate infiltrates involving the left lung.  Small- to moderate-sized right pleural effusion.  Small left pleural effusion which appears to be somewhat loculated. 2.  Mildly enlarged pretracheal lymph node may be reactive in nature.  Cardiomegaly.  FINDINGS CT ABDOMEN AND PELVIS:  Motion degrades image quality.  The small bowel and colon are grossly negative for wall thickening.  Moderate amount of stool in the rectosigmoid region.  There is mild-to-moderate left-sided colon diverticulosis without discrete diverticulitis change.  Gas involving the subcutaneous fat along the ventral abdominal wall may reflect an injection site.  There is nonspecific mild edematous change involving the subcutaneous fat over the abdomen and pelvis.  Mild ectatic abdominal aorta measuring up to 2.5 mm.  Moderate-to-extensive atherosclerotic disease in the aorta and iliac vessels.  Liver, spleen, pancreas, kidneys, and adrenal glands are grossly negative. Urinary bladder negative.  Presumed hysterectomy.  Mild degenerative changes in the spine.  Presumed hemangioma involving the L2 vertebral body.  IMPRESSION:  1.  Image quality is degraded due to motion.  Abdomen and pelvis are grossly negative for acute change. 2.  Gas seen along the ventral abdominal wall may reflect an injection site.  There is nonspecific edematous change involving the subcutaneous fat over the abdomen and pelvis.