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September 2015 Pulmonary Case of the Month: Holy Smoke

Samir Sultan, DO

David M. Baratz, MD

Banner University Medical Center Phoenix

Phoenix, AZ


History of Present Illness

A 43-year-old woman presents to the office for second opinion of her dyspnea. She has very mild dyspnea with exertion which she notices when she cannot keep up with people going up stairs. She also has a "smoker’s cough".

Past Medical History, Family History, Social History

Her past medical history, family history and social history are unremarkable other than she smokes 1 ppd for the past 20 years and had a "collapsed lung" about 15 years ago.

Physical Examination

Her physical examination was unremarkable except for a small scar on her right chest.


A chest x-ray (Figure 1) was performed. 


Figure 1. PA (Panel A) and lateral (panel B) chest radiography.

Which of the following are true regarding the chest x-ray? (Click on the correct answer to proceed to the second of five panels)

  1. The chest -ray shows a widened mediastinum
  2. The chest x-ray is normal
  3. The chest x-ray shows a diffuse reticulonodular infiltrate
  4. The chest x-ray shows bilateral hilar adenopathy
  5. The chest x-ray shows small bilateral pleural effusions

Cite as: Sultan S, Baratz DM. September 2015 puilmonary case of the month: holy smoke. Southwest J Pulm Crit Care. 2015;11(3):90-6. doi: PDF

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