November 2022 Imaging Case of the Month: Out of Place in the Thorax

Michael B. Gotway MD

Department of Radiology, Mayo Clinic, Arizona

5777 East Mayo Boulevard

Phoenix, Arizona USA

History of Present Illness: A 30-year-old woman presented with complaints of left-sided back pain and numbness. She denied any history of trauma.

PMH, SH, FH:  No significant past medical history.  She denied smoking and use of illicit substances. Her family history was largely unremarkable, positive only for a history of gastrointestinal stromal tumor affecting her father.

Medications: Her medications included fluoxetine, spironolactone, and Celebrex (celecoxib).

Physical Examination: The patient’s physical examination showed her to be afebrile with pulse rate and blood pressure within the normal range.

Laboratory Evaluation: A complete blood count showed a hemoglobin and hematocrit value of 14.3 gm/dL (normal, 13.2-16.6 gm/dL) and 41.5% (normal, 38.3-48.6%) and a platelet count of 253 x x10⁹/L (normal, 135-317 x10⁹/L). The white blood cell count was normal at 6.9 x10⁹/L (normal, 3.4-9.6 x10⁹/L), with no left shift. The eosinophil count was normal. Liver function studies were entirely normal. Serum chemistries were completely within normal limits aside from a minimally elevated serum calcium level of 10.1 mg/dL (normal, 6.6-10 mg/dL).

Frontal chest radiography (Figure 1) was performed.

Figure 1. Frontal chest radiography shows normal heart size, clear lungs, no evidence of pleural effusion or peribronchial or mediastinal lymph node enlargement.

Which of the following represents an appropriate interpretation of the frontal chest and lateral radiograph? (Click on the correct answer to be directed to the second of 11 pages)

1. Frontal chest radiography shows normal findings
2. Frontal chest radiograph shows numerous small nodules
3. Frontal chest radiography shows rib abnormalities
4. None of the above
5. More than one of the above

Cite as: Gotway MB. November 2022 Imaging Case of the Month: Out of Place in the Thorax. Southwest J Pulm Crit Care Sleep. 2022;25(5):61-66. doi: https://doi.org/10.13175/swjpcc049-22 PDF