August 2015 Imaging Case of the Month

Michael B. Gotway, MD

Department of Radiology 

Mayo Clinic Arizona

Scottsdale, AZ

Clinical History: A 69-year-old man with a history of hairy cell leukemia, in remission, and “smoldering” multiple myeloma (IgG kappa and M-spike with IgM kappa light chain), as well as obstructive sleep apnea treated with continuous positive airway pressure, presents with slowly progressive dyspnea, occasional cough (sometimes productive of yellow sputum) and fatigue, the latter associated with difficulty sleeping and daytime somnolence. Overnight oximetry disclosed 75% of the patient’s oxygen saturations were less than 90%. He is a former smoker (2.5 cigarettes / day for 15 years), but uses cannabis chronically. A chest radiograph (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 nine panels)

1. The frontal chest radiograph shows abnormal mediastinal contours
2. The frontal chest radiograph shows basal predominant fibrotic abnormalities
3. The frontal chest radiograph shows bilateral nodules and masses
4. The frontal chest radiograph shows large lung volumes with a cystic appearance
5. The frontal chest radiograph shows no abnormal findings

Reference as: Gotway MB. August 2015 imaging case of the month. Southwest J Pulm Crit Care. 2015;11(2):70-81. doi: http://dx.doi.org/10.13175/swjpcc108-15 PDF