February 2018 Imaging Case of the Month

Michael B. Gotway, MD

Department of Radiology

Mayo Clinic Arizona

Scottsdale, AZ USA

Clinical History: An 18-year-old woman with a questionable history of asthma (one physician source claimed no clear history of asthma, whereas another source claimed severe asthma) presented to the emergency room with worsening shortness of breath and cough. The patient’s past medical history was otherwise largely unremarkable. She did have complaints of recurrent rhinorrhea and allergies, for which sinus CT (Figure 1) had been performed.

Figure 1. Unenhanced axial sinus CT shows multifocal sinus opacification (arrow = maxillary sinuses, arrowheads = ethmoid sinuses, double arrowhead= sphenoid sinus)

Physical examination was remarkable for coarse, right-greater-than-left basal rales and coarse breath sounds. The patient’s oxygen saturation was 98% on room air. Her nasal septum appeared deviated. The patient’s vital signs were within normal limits and she was afebrile.

Laboratory evaluation showed a normal complete blood count, electrolyte panel, and liver function tests. A digital frontal chest image (Figure 2) obtained at presentation is shown, with a comparison chest radiograph from 5 months earlier also shown.

Figure 2. A: Digital frontal chest image. B: Chest radiograph from 5 months earlier.

Which of the following represents the most accurate assessment of the frontal chest imaging findings? (Click on the correct answer to proceed to the second of seven pages)

1. Chest frontal imaging shows basilar fibrosis
2. Chest frontal imaging shows mediastinal and peribronchial lymphadenopathy
3. Chest frontal imaging shows multiple, bilateral small nodules
4. Chest frontal imaging shows normal findings
5. Chest frontal imaging shows patchy nodular opacities in the right lung

Cite as: Gotway MB. February 2018 imaging case of the month. Southwest J Pulm Crit Care. 2018;16(2):67-75. doi: https://doi.org/10.13175/swjpcc019-18 PDF