June 2016 Imaging Case of the Month

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): 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 65-year-old non-smoking man with a past medical history significant only for dyslipidemia and hypertension presented to the emergency room with a 2-week complaint of intermittent, diffuse, high back pain accompanied by sweating and nausea and non-bloody emesis. The back pain does not radiate. The patient also notes that recently he has suffered from pronounced fatigue and some shortness of breath; until recently he had been an endurance athlete.

Physical Examination: Physical examination was normal; in particular, the back pain was not reproducible on palpation. The patient was afebrile.

Laboratory: Laboratory data were remarkable for a mildly elevated white blood cell count of 11 x 10⁹ cells/L. Serum chemistries were within normal limits and cardiac troponins were negative. Oxygen saturation on room air was 94%.

Radiography: 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 eight panels)

1. The frontal chest radiograph shows a large left pleural effusion
2. The frontal chest radiograph shows an abnormally widened mediastinum
3. The frontal chest radiograph shows multifocal consolidation
4. The frontal chest radiograph shows no significant findings
5. The frontal chest radiograph shows numerous small lung nodules

Cite as: Gotway MB. June 2016 imaging case of the month. Southwest J Pulm Crit Care. 2016 Jun;12(6):216-28. doi: http://dx.doi.org/10.13175/swjpcc047-16 PDF