April 2017 Imaging Case of the Month

Michael B. Gotway, MD and John K. Sweeney, MD

Department of Radiology

Mayo Clinic Arizona

Scottsdale, Arizona USA

Clinical History: An 86-year-old man with a previous history of transcatheter aortic valve implantation 1 year earlier, coronary artery disease status-post coronary artery bypass grafting surgery 12 years earlier, atrial fibrillation on warfarin, and pacemaker placement 8 years earlier presented with altered mental status.

The patient’s white blood cell count was borderline elevated at 10.3 x 10³/mcl (normal, 4.8 – 10.8 x 10³/mcl)  and hyponatremia was noted (serum sodium = 129 mEq/L, normal =  136 – 145 mEq/L). The patient’s anticoagulation profile was within the therapeutic range (INR = 1.4), and the platelet count was normal. Oxygen saturation on room air was normal. The patient’s medication list included warfarin, digoxin, aspirin, metoprolol, montelukast, and atorvastatin.

Frontal chest radiography (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 eight pages)

1. Frontal chest radiography shows a cavitary lung mass
2. Frontal chest radiography shows focal consolidation suggesting aspiration pneumonia
3. Frontal chest radiography shows increased pressure edema
4. Frontal chest radiography shows malposition of the patient’s left subclavian pacemaker
5. Frontal chest radiography shows rib fractures

Cite as: Gotway MB, Sweeney JK. April 2017 imaging case of the month. Southwest J Pulm Crit Care. 2017;14(4):141-52. doi: https://doi.org/10.13175/swjpcc042-17 PDF