July 2025 Medical Image of the Month: A Case of Severe Hiatal Hernia Presenting as Atypical Chest Pain

By: Goduguchinta V, Patel R, Al-Mubaid A, Hammad M

Abstract: No abstract available. Article truncated after first 150 words. A 73-year-old woman with a past medical history including coronary artery disease (CAD), prior myocardial infarction (MI), cardiomyopathy, hypertension, obstructive sleep apnea (OSA) on CPAP, gastroesophageal reflux disease (GERD),and a history of pulmonary embolism on apixaban presented to the emergency department with six hours of chest pain. She described the pain as pressure-like, radiating from beneath the left breast to the left axilla and back. She also reported associated nausea without vomiting and poor oral intake but maintained normal bowel movements. She denied fever, chills, dyspnea, vomiting, diarrhea, constipation, or abdominal pain. The patient recalled a similar episode during her MI ten years prior, prompting her to seek medical care.

Vital signs were stable. Cardiac workup included serial troponins, both of which were negative (at 8 and 7 respectively), and an electrocardiogram (EKG) showing normal sinus rhythm without ST-T wave abnormalities. Chest x-ray (Figure 1) demonstrated a retrocardiac opacity suggestive …

URL: https://www.swjpcc.com/imaging/2025/7/2/july-2025-medical-image-of-the-month-a-case-of-severe-hiatal.html 

July 2025 Imaging Case of the Month: A Growing Lung Nodule in a Patient with Heart Disease

By: Stib MT, Gotway MB

Abstract: No abstract available. Article truncated after 150 words. Clinical History: A 36-year-old woman with a history of unspecified anemia, treated with occasional iron infusion, and Hashimoto thyroiditis presented to the Emergency Room with complaints of chest pain, sharp and non-radiating worsening in the supine position and improving with sitting upright and leaning forward, blurred vision, bilateral upper extremity weakness and numbness, and intermittent subjective low-grade fever. These symptoms had been present for about 1 month prior to presentation in the Emergency Room.

The patient’s past medical history was otherwise unremarkable. She is a 20-pack-year smoker with no allergies. Her past surgical history was remarkable only for bilateral breast augmentation, tonsillectomy, and 2 C-sections. Her only medications included a multivitamin and vitamin D3 supplementation.

The patient’s vital signs included a blood pressure of 115/71 mmHg, a pulse rate of 95 / minute, a respiratory rate of 18 / minute and a temperature of 38.4°C. Pulse oximetry on room air …

URL: https://www.swjpcc.com/imaging/2025/7/1/july-2025-imaging-case-of-the-month-a-growing-lung-nodule-in.html 

June 2025 Medical Image of the Month: Neurofibromatosis-Associated Diffuse Cystic Lung Disease

By: Ali A

Abstract: 

No abstract available. Article truncated after 150 words. A 61-year-old man with a history of neurofibromatosis type 1 (NF1) and NF1-associated cystic lung disease presented for a routine follow-up visit 5 years post-bilateral lung transplantation.  The patient’s physical examination revealed multiple cutaneous neurofibromas, consistent with his diagnosis of NF1 (Figure 1).  Additionally, he had a prior tracheostomy scar; he temporarily required tracheostomy post lung transplant surgery.

Pre-Transplant History:

The patient had progressive chronic hypoxic respiratory failure, requiring home oxygen supplementation at up to 8 L/min. His medical history included a 15-pack-year smoking history, though he quit smoking 16 years prior to his lung transplant.  His diagnostic workup prior to transplant consisted of a high-resolution computed tomography (HRCT) of the chest, which  revealed diffuse cystic lung disease with intervening ground-glass opacities (Figure 2), an echocardiogram, which demonstrated severe pulmonary hypertension, and pulmonary function tests (PFTs), which  showed a combined restrictive and obstructive pattern with severely reduced DLCO at 25%. …

URL: https://www.swjpcc.com/imaging/2025/6/2/june-2025-medical-image-of-the-month-neurofibromatosis-assoc.html 

June 2025 Pulmonary/Critical Care Case of the Month: Hemoptysis from a Very Unusual Cause

By: Raschke RA, Kayani A, Gotway MB

Abstract: 

No abstract available. Article truncated after 150 words. A 23-year-old man presented to our hospital emergency room (ER) with one week of non-productive cough and mild pleuritic chest pain followed by 24 hours of hemoptysis, producing about a teaspoon of bright red blood every 15 mins. His blood pressure was 146/83, HR 103, RR 16, temperature 98.6 F. and room air oxygen saturation was 96%. He was in no respiratory distress and his physical examination was unremarkable. 

Initial laboratory studies including a white blood cell count, serum electrolytes, glucose, and renal function, liver indices, a coagulation profile, a procalcitonin level, and a urinalysis were all within normal limits. A PCR for SARS-CoV-2, influenza and RSV was negative.

Which of the following are true regarding massive hemoptysis?

1. It can be defined by as little as 150ml (about a half cup) of hemoptysis per day
2. Urgent bronchoscopy is indicated to remove obstructive blood clots, and to localize and …

URL: https://www.swjpcc.com/pulmonary/2025/6/1/june-2025-pulmonarycritical-care-case-of-the-month-hemoptysi.html

May 2025 Medical Image of the Month: Aspirated Dental Screw

By: Osueni A, Vasudevan A, Gajendiran AP, Arul G, Gunasekaran K

Abstract: 

No abstract available. Article truncated after 150 words. An 80-year-old man with no significant past medical history presented to the emergency department with cough following a routine dental procedure. He reported intermittent coughing but denied chest pain, shortness of breath, palpitations, or dizziness. On physical examination, he appeared comfortable, with stable vital signs and no signs of respiratory distress. Cardiovascular, respiratory, and neurological examinations were unremarkable. A chest radiograph (Figure 1A) revealed a metallic foreign body in the right main bronchus. Laboratory investigations were within normal limits. Given the radiologic findings and stable clinical status, the patient was intubated and underwent flexible bronchoscopy. The procedure revealed a grayish metallic foreign body lodged in the right middle lobe bronchus (Figure 1C), which was successfully removed using a snare technique. No bleeding, trauma, or complications were observed. The extracted object measured 2.5 cm (Figure 1D) and appeared as a silver metallic dental screw with a sharp, broad base. Bronchial secretions …

URL: https://www.swjpcc.com/imaging/2025/5/2/may-2025-medical-image-of-the-month-aspirated-dental-screw.html