May 2022 Imaging Case of the Month: Asymmetric Apical Opacity–Diagnostic Considerations
Sunday, May 1, 2022 at 8:00AM Department of Radiology
Mayo Clinic, Arizona
Phoenix, Arizona USA
Clinical History: A 64–year–old woman presented to the emergency room with complaints of right arm pain for 2 months accompanied by subjective low-grade intermittent fevers.
The patient’s past medical history was unremarkable and she had never had surgery. She had been a smoker for most of her life, at least 25-pack-years. She denied allergies, admitted to moderate daily alcohol use, and denied illicit drug use.
The patient’s physical examination showed no clear focal abnormalities and she was afebrile. She did have some right scapular tenderness to palpation, although there were no abnormal skin changes over this region. Her pulse rate and blood pressure were within normal limits, and her room air oxygen saturation was 96%. Basic laboratory data, including a complete blood count and electrolytes were largely within the normal range. The patient’s white blood cell count was technically abnormal at 9.7 x109 (normal, 3.4 - 9.6 x 109), but there was no left shift and the treating emergency room physician felt the mildly elevated white blood cell count was of no clinical significance.
Frontal and lateral chest radiography (Figure 1) was performed.
Figure 1. Frontal (A) and lateral (B) chest radiography.
Which of the following represents an appropriate interpretation of her frontal chest and lateral radiograph? (Click on the correct answer to be directed to the second of twelve pages)
- Frontal chest radiography shows multifocal consolidation
- Frontal chest radiograph shows numerous small nodules
- Frontal chest radiography shows a focal mass
- Frontal chest radiography shows a destructive bone lesion
- Frontal chest radiography shows pleural effusion
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