CT of chest results/Echo clearance

We have a 87 yr old male who has been ordered 40 HBO treatments for STRN (radiation cystitis). Pt has sleep apnea, CHF, and afib. His CXR findings: Heart is mildly enlarged. There is calcification of the thoracic aorta. There is blunting of the right costophrenic angle which may be due to small pleural effusion or pleural thickening. There is otherwise no active pulmonary disease seen with
no pneumothorax noted. There are degenerative changes of the thoracic spine. Impression: Small right pleural effusion or right basilar pleural thickening. Otherwise, no active pulmonary disease. Mild cardiomegaly.
CT of chest was ordered and findings showed: Tortuous aorta. Aneurysmal ascending aorta 44 x 45 mm. A 4 cm aortic arch diameter. A 31 mm descending aorta. Trace right pleural effusion, Minimal adjacent lung atelectasis or infiltrate. Minimal linear fibrous changes in the lungs, with mosaic aeration in the left lung base.
Our Medical Director spoke with a CV surgeon and he has agreed to follow up with the pt as a new provider. He states pt is ok to proceed with HBO but we wanted to do this curbside consult to get the panels opinion.

Apr 3, 2023 by Missy Smith, BSN, RN, CHRN

1 replies

Elaine Horibe Song
MD, PhD, MBA

Hi Missy,
Thanks for your question. Dr Robinson, Jeff and I talked about it and here are some thoughts:
Due to the history of CHF, if clinical findings suggest uncontrolled CHF, a referral to a cardiologist for better CHF control would be recommended prior to HBOT. Just by reviewing the CT scan report per se (without additional data on clinical findings), there does not appear to be a specific contraindication to HBOT. It'd be important to slow down the ascent rate and monitor the patient for any increase in systemic vascular resistance that could lead to heart failure.

Apr 5, 2023

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