August 2020 Imaging Case of the Month: Piecing Together a Cause for Multisystem Abnormalities

Prasad M. Panse MD

Clinton E. Jokerst MD

Michael B. Gotway MD

Department of Radiology

Mayo Clinic Arizona

Scottsdale, AZ USA

Clinical History: A 65-year-old woman with chronic hoarseness and dyspnea now presents with complaints of diarrhea and bloating. The patient indicated her dyspnea had developed over the previous year, now occurring after one flight of stairs. The patient also complains of some substernal burning after waling 2-3 blocks. Her past medical history was largely unremarkable, and her past surgical history included only a cesarean section and carpal tunnel surgery. She has no allergies and her medications included thyroxine, fluoxetine, and a steroid inhaler. She was a previous smoker for 8 years, quitting 30 years ago. Upon directed questioning, the patient also complains of generalized weakness and 13-14 lbs. weight loss in the previous year.

Physical examination showed normal vital signs and was remarkable only for atrophy of the patient’s right calf muscles, which the patient claimed she knew about and had occurred over the previous year and a half. The neurologic examination was entirely normal. The examining physician noted that the patient’s tongue appeared somewhat enlarged and reddened, but was not coated and midline upon protrusion.

The patient’s complete blood count and serum chemistries showed all values within the normal range except for a serum albumin level of 2.9 gm/dL (normal, 3.5-5 gm/dL). Her erythrocyte sedimentation rate was mildly elevated at 55 mm/h (normal, 0-29 mm/hr). The patient was referred for chest radiography (Figure 1).

Figure 1. Frontal (A) and lateral (B) chest radiography.

Which of the following statements regarding the chest radiograph is most accurate? (Click on the correct answer to be directed to the second of nine pages)

1. The chest radiograph shows mediastinal and peribronchial lymph node enlargement
2. The chest radiograph shows multifocal basal consolidation
3. The chest radiograph shows normal findings
4. The chest radiograph shows numerous small nodules
5. The chest radiograph shows small bilateral pleural effusions

Cite as: Panse PM, Jokerst CE, Gotway MB. August 2020 imaging case of the month: piecing together a cause for multisystem abnormalities. Southwest J Pulm Crit Care. 2020;21(2):23-34. doi: https://doi.org/10.13175/swjpcc045-20 PDF 

February 2016 Imaging Case of the Month

Michael B. Gotway, MD

Department of Radiology

Mayo Clinic Arizona

Scottsdale, AZ

Imaging Case of the Month CME Information  

Members of the Arizona, New Mexico, Colorado and California Thoracic Societies and the Mayo Clinic are able to receive  0.25 AMA PRA Category 1 Credits™. Completion of an evaluation form is required to receive credit and a link is provided on the last panel of the activity.

0.25 AMA PRA Category 1 Credit(s)™

Estimated time to complete this activity: 0.25 hours

Lead Author(s): Michael B. Gotway, MD. All Faculty, CME Planning Committee Members, and the CME Office Reviewers have disclosed that they do not have any relevant financial relationships with commercial interests that would constitute a conflict of interest concerning this CME activity. 

Learning Objectives:
As a result of this activity I will be better able to:    

1. Correctly interpret and identify clinical practices supported by the highest quality available evidence.
2. Will be better able to establsh the optimal evaluation leading to a correct diagnosis for patients with pulmonary, critical care and sleep disorders.
3. Will improve the translation of the most current clinical information into the delivery of high quality care for patients.
4. Will integrate new treatment options in discussing available treatment alternatives for patients with pulmonary, critical care and sleep related disorders.

Learning Format: Case-based, interactive online course, including mandatory assessment questions (number of questions varies by case). Please also read the Technical Requirements.

CME Sponsor: University of Arizona College of Medicine at the Arizona Health Sciences Center.

Current Approval Period: January 1, 2015-December 31, 2016

Financial Support Received: None.

Clinical History: A 78 year-old woman presented to her physician for routine care. Her past medical history included hyperlipidemia, hypothyroidism, gout, hypertension, and arthritis.

Although she was asymptomatic, screening frontal and lateral chest radiography (Figure 1) was performed.

Figure 1. Frontal (A) and lateral (B) chest radiography.

Which of the following statements regarding the chest radiograph is most accurate? (Click on the correct answer to proceed to the second of nine panels)

1. The frontal chest radiograph shows a poorly defined nodular opacity in the left upper lung
2. The frontal chest radiograph shows abnormal mediastinal contours
3. The frontal chest radiograph shows basal predominant fibrotic abnormalities
4. The frontal chest radiograph shows large lung volumes with a cystic appearance
5. The frontal chest radiograph shows no abnormal findings

Cite as: Gotway MB. February 2016 imaging case of the month. Southwest J Pulm Crit Care. 2016;12(2):48-58. doi: http://dx.doi.org/10.13175/swjpcc014-16 PDF

October 2014 Imaging Case of the Month

Sameh Sakla, M.D.

Clinton Jokerst, M.D.

Department of Medical Imaging

University of Arizona Medical Center

Tucson, AZ

A 53-year-old man presents with fatigue and dyspnea on exertion. An admission chest radiograph (Figure 1) was obtained.

Figure 1. Admission chest radiograph.

What is the best term or phrase used to describe the salient radiographic abnormality?

1. Diffuse thick-walled cavitary lesions
2. Interstitial and alveolar pulmonary edema with effusions
3. Miliary nodules
4. Patchy consolidation
5. Tension pneumothorax

Reference as: Sakla S, Jokerst C. October 2014 imaging case of the month. Southwest J Pulm Crit Care. 2014;9(4):214-8. doi: http://dx.doi.org/10.13175/swjpcc126-14 PDF 

Medical Image of the Week: Amyloidosis

A 60-year-old man with multiple pulmonary calcified nodules and masses was found to have nodular pulmonary light chain amyloidosis with a G kappa light chain in serum. He underwent stem cell transplant in 2003. In 2009, he was found to have pulmonary hypertension. Despite therapy, pulmonary hypertension and amyloidosis progressed.

Figure 1: Axial CT scan of the chest, lung and mediastinal windows, showing multiple calcified pulmonary nodules and masses secondary to Amyloidosis

Steven Knoper, MD; Carmen Luraschi-Monjagatta, MD and Aarthi Ganesh, MD

Division of Pulmonary, Allergy, Critical Care and Sleep Medicine

Arizona Respiratory Center

University of Arizona

Tucson, Arizona

Refernce as: Knoper S, Luraschi-Monjagatta C, Ganesh A. Medical image of the week: amyloidosis. Southwest J Pulm Crit Care 2013;6(1):52. PDF

September 2012 Imaging Case of the Month

Michael B. Gotway, MD

Associate Editor Imaging

Department of Radiology

Mayo Clinic Arizona

Scottsdale, AZ

Clinical History: A 35-year-old non-smoking man presented with a history of slowly progressive shortness of breath preceded by cough and wheezing, previously presumptively diagnosed with asthma. He had a previous history of ulcerative colitis and a +PPD for which he received 6 month INH therapy. Frontal and lateral chest radiography (Figure 1) was performed.

Figure 1. Panel A: Frontal chest radiography. Panel B: Lateral chest radiography.

Which of the following statements regarding the chest radiograph is accurate?

1. The radiograph shows a diffuse interstitial abnormality
2. The radiograph appears normal
3. The radiograph shows cystic lung disease
4. The radiograph a mediastinal contour abnormality
5. The radiograph shows abnormal lung volumes

Reference as: Gotway MB. September 2012 imaging case of the month. Southwest J Pulm Crit Care 2012;5:126-34. (Click here for a PDF version)