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 

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

January 2012 Case of the Month

Michael B. Gotway, MD

Associate Editor Imaging

Clinical History

A 69-year-old woman with no significant past medical history presented with progressive shortness of breath. A chest radiograph (Figure 1) was obtained.

Figure 1. Frontal chest radiograph.

How would you describe the findings on the chest radiograph (Figure 1)?

1. Multifocal consolidation
2. Blunting of the costophrenic angles suggesting pleural effusion
3. Multifocal reticulonodular opacities
4. Bilateral cavitary lung consolidation
5. Miliary nodular opacities

Reference as: Gotway MB. January 2012 case of the month. Southwest J Pulm Crit Care 2012;4:12-18. (Click here for a PDF version)