December 2016 Imaging Case of the Month

Eric A. Jensen, MD

Michael B. Gotway, MD 

Department of Radiology

Mayo Clinic Arizona

Scottsdale, AZ USA

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): Eric A. Jensen, 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

Clinical History: A 47-year-old woman presented for medical evaluation prior to trans-sphenoid hypophysectomy for pituitary adenoma for Cushing syndrome. The patient had an extensive past medical history, including kidney minimal change disease treated with corticosteroids between 5-7 years previously (no longer on corticosteroid therapy), type II diabetes mellitus, focal segmental glomeruloscleroosis on renal biopsy, morbid obesity, gout, obstructive sleep apnea on continuous positive airway pressure (CPAP) supplemented with oxygen for the previous 8 years, hypertension, and recent-onset atrial fibrillation, as well as a history of several pneumonias, perhaps related to chronic immunosuppression. Her past surgical history included bilateral partial knee replacement, lower extremity vein ablation, and breast reduction. Her medication list was extensive, including allopurinol, anti-hypertensives, anti-depressants, colchicine, oxygen, and Tacrolimus, among others, including over-the-counter medications.

Laboratory data, include white blood cell count, coagulation profile, and serum chemistries were within normal limits. Oxygen saturation on room air was 95%.

Frontal and lateral chest radiographs (Figure 1) were performed. A previous chest radiograph performed 2 years earlier is presented for comparison (Figure 2).

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

Figure 2.  Frontal chest radiography performed 2 years prior to presentation.

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

1. Frontal and lateral chest radiography appears normal
2. Frontal and lateral chest radiography shows a mass projected over the right paratracheal region
3. Frontal and lateral chest radiography shows asymmetric hyperlucency affecting the right thorax
4. Frontal and lateral chest radiography shows basal reticulation suggesting possible fibrotic disease
5. Frontal and lateral chest radiography shows cardiomegaly only, but is unchanged from prior

Cite as: Jensen EA, Gotway MB. December 2016 imaging case of the month. Southwest J Pulm Crit Care. 2016;13(6):290-301. doi: https://doi.org/10.13175/swjpcc135-16 PDF