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April 2017 Imaging Case of the Month

Michael B. Gotway, MD and John K. Sweeney, MD

Department of Radiology

Mayo Clinic Arizona

Scottsdale, Arizona 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, 2017-December 31, 2018


Clinical History: An 86-year-old man with a previous history of transcatheter aortic valve implantation 1 year earlier, coronary artery disease status-post coronary artery bypass grafting surgery 12 years earlier, atrial fibrillation on warfarin, and pacemaker placement 8 years earlier presented with altered mental status.

The patient’s white blood cell count was borderline elevated at 10.3 x 103/mcl (normal, 4.8 – 10.8 x 103/mcl)  and hyponatremia was noted (serum sodium = 129 mEq/L, normal =  136 – 145 mEq/L). The patient’s anticoagulation profile was within the therapeutic range (INR = 1.4), and the platelet count was normal. Oxygen saturation on room air was normal. The patient’s medication list included warfarin, digoxin, aspirin, metoprolol, montelukast, and atorvastatin.

Frontal 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 pages)

  1. Frontal chest radiography shows a cavitary lung mass
  2. Frontal chest radiography shows focal consolidation suggesting aspiration pneumonia
  3. Frontal chest radiography shows increased pressure edema
  4. Frontal chest radiography shows malposition of the patient’s left subclavian pacemaker
  5. Frontal chest radiography shows rib fractures

Cite as: Gotway MB, Sweeney JK. April 2017 imaging case of the month. Southwest J Pulm Crit Care. 2017;14(4):141-52. doi: https://doi.org/10.13175/swjpcc042-17 PDF

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