August 2025 Medical Image of the Month: Crazy Paving in a Case of Eosinophilic Granulomatosis with Polyangiitis

By: Wengler JC, Jokerst C

Abstract: 

No abstract available. Manuscript truncated after 150 words. A 73-year-old woman with a history of eosinophilic granulomatosis with polyangiitis (EGPA), and heart failure with preserved ejection fraction presented to the hospital with acute pancreatitis and developed acute (on-chronic) hypoxic respiratory failure during treatment. Her previous EGPA complications included interstitial lung disease (ILD) as well as GI, skin, and cardiac involvement. She was being treated with rituximab and mepolizumab at the time of admission. However, this treatment had not improved her skin rashes, late-onset asthma, or arthralgias.

At admission, the patient was on a baseline of 3L oxygen, which worsened to 7-12L upon beginning IV fluids. The patients' labs were pertinent for B-type natriuretic peptide (BNP) 9378 pg/ml (normal <100pg/ml, increased from _~2000 2-months prior), lipase 702 U/L (normal , 0-160) and an absolute eosinophil count of 390cells/µL  (normal 0-500). The transthoracic echocardiogram results were unchanged from four months prior, and diuresis failed to improve oxygen needs, raising the …

URL: https://www.swjpcc.com/imaging/2025/8/2/august-2025-medical-image-of-the-month-crazy-paving-in-a-cas.html

August 2025 Pulmonary Case of the Month: Respiratory Failure Occurring in a Meat Packing Plant

By: Von Essen SG

Abstract: 

No abstract available. Article truncated after 150 words. A 32-year-old healthy meat packing plant worker was hospitalized for shortness of breath. He normally worked on the kill floor of a local pork processing plant. On the day he was seen he had been reassigned, just for the day, to the room where brine was mixed and hams were placed into it for curing. The hams were smoked after the curing and were not smoked in that room. He developed shortness of breath and he was taken to the Nebraska Medicine emergency room.

He was a native of Myanmar and spoke English poorly Physical examination revealed a man who appeared to be about the stated age severely short of breath with a respirator rate of 36-40 breaths/min. He was febrile at 38.6° C and tachycardic at 116 beats/min. His physical examination was otherwise normal except for a question of rales at the bases.

Which of the following should be …

URL: https://www.swjpcc.com/pulmonary/2025/8/1/august-2025-pulmonary-case-of-the-month-respiratory-failure.html 

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