August 2019 Imaging Case of the Month: A 51-Year-Old Man with a Headache 
Thursday, August 1, 2019 at 8:00AM
Rick Robbins, M.D. in AVM, CT scan, angle to pleura, arteriovenous malformation, chest x-ray, coil occlusion, coils, pulmonary AVM, pulmonary angiogram, treatment

Michael B. Gotway, MD

Department of Radiology

Mayo Clinic Arizona

Scottsdale, AZ USA


Imaging Case of the Month CME Information  

Completion of an evaluation form is required to receive credit and a link is provided on the last panel of the activity.

0.50 AMA PRA Category 1 Credit(s)™

Estimated time to complete this activity: 0.50 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 completing this activity, participants will be better able to:

  1. Interpret and identify clinical practices supported by the highest quality available evidence.
  2. Establish the optimal evaluation leading to a correct diagnosis for patients with pulmonary, critical care and sleep disorders.
  3. Translate the most current clinical information into the delivery of high quality care for patients.
  4. Integrate new treatment options 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, 2019-December 31, 2020  


Clinical History: A 51-year-old previously healthy man presented with complaints of increasing headache frequency and severity. The patient noted headaches in the past, but that the frequency of these headaches, which he referred to as “migraines,” had been increasing in recent months. The patient does note some auras with the headaches.

The patient reported a history of pneumonia in the past, but denied recurrent pneumonias. The only medication the patient takes was ibuprofen, for his headaches; he denied allergies. The patient’s past surgical history was remarkable only for a right inguinal hernia repair, a right Achilles tendon injury repair, and surgical removal of a palpable left thigh mass, ultimately shown to represent scar tissue. The patient smoked 1-8 cigarettes / day for 35 years, quitting one year earlier.

The patient’s physical examination was remarkable for obesity (BMI= 30.4). His vital signs were within the normal range. A few reddish rounded spots were noted on his lower lip, but no other abnormalities were noted at physical examination.

Basic laboratory data, including a complete blood count, electrolyte panel, B12 and folate levels, a C-reactive protein level, and liver function studies were all within the normal range. Mild hypercholesterolemia was noted. An electrocardiogram revealed normal findings. As part of a routine office visit, frontal and lateral chest radiography (Figure 1) was performed.  

Figure 1. Frontal and lateral 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 ten pages)

  1. The chest radiograph shows circumscribed nodular opacities
  2. The chest radiograph shows multifocal nodular pulmonary consolidation
  3. The chest radiograph shows multiple, bilateral cavitary nodules
  4. The chest radiograph shows multiple, bilateral small circumscribed nodules
  5. The chest radiograph shows nodular interstitial thickening

Cite as: Gotway MB. August 2019 imaging case of the month: a 52-year-old man with a headache. Southwest J Pulm Crit Care. 2019;19(2):52-64. doi: PDF 

Article originally appeared on SOUTHWEST JOURNAL of PULMONARY & CRITICAL CARE (
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