September 2013 Pulmonary Case of the Month: Chewing the Cud
Sunday, September 1, 2013 at 6:52AM Suresh Uppalapu, MD
Manoj Mathew, MD
Banner Good Samaritan Medical Center
Phoenix, AZ
History of Present Illness
A 30 year old Hispanic man presented to the emergency department (ED) after being involved in a motor vehicle accident. He was a restrained passenger and his car was hit from behind by another vehicle. His initial presenting complaints were chest and back pain.
PMH, SH, FH
The patient was originally born in Sonora, Mexico but moved to the Phoenix area in 1998. However, he traveled to Mexico frequently. He has no allergies and no significant past medical or surgical history.
His social habits include occasional alcohol consumption and a remote minimal smoking history. He denied illicit drug abuse. He was married and has 5 healthy children. He was working as a fork lift operator in a warehouse and was not taking any medications. A tuberculosis skin test and a human immunodeficiency virus (HIV) were negative 3 years ago when he applied for US Citizenship.
His parents are alive with hypertension and type 2 diabetes mellitus.
Physical Examination
His physical exam had normal vital signs and a Glasgow coma scale of 15. Physical exam showed clear lungs, normal heart sounds, and a benign abdominal exam. His neurological exam was normal.
Laboratory
His complete blood count (CBC) showed a white blood cell (WBC) count of 15.4 x 106 cells/mcL, hemoglobin of 11.8 g/dL, a hematocrit of 36 % and a normal platelet count. His basic metabolic profile and liver function chemistries were normal.
Radiography
His chest x-ray is shown in Figure 1.
Figure 1. Admission PA (Panel A) and lateral (Panel B) chest x-ray.
Which of the following best describes the chest x-ray?
- A density in the right chest consistent with a fractured right mainstem bronchus
- An air-fluid level in the right chest consistent with a lung abcess
- Consolidation in the lateral right lung
- All of the above
- None of the above
Reference as: Uppalapu S, Mathew M. September 2013 pulmonary case of the month: chewing the cud. Southwest J Pulm Crit Care. 2013;7(3):135-41. http://dx.doi.org/10.13175/swjpcc103-13 PDF
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