January 2013 Pulmonary Case of the Month: Maybe We Should Call GI

Lewis J. Wesselius, MD

Department of Pulmonary Medicine

Mayo Clinic Arizona

Scottsdale, AZ

History of Present Illness

A 55 year old man from Arizona was undergoing a renal transplant evaluation because of polycystic kidney disease. He was referred for an abnormal chest x-ray. He was a nonsmoker and there were no respiratory symptoms.

PMH, FH and SH

He has a long history of polycystic kidney disease, hypertension, gout, and a history of a kidney stone. He is a life-long nonsmoker. There is no significant family history including polycystic kidney disease. He works as a border patrol agent and is originally from Honduras. His present medications include:

• Allopurinol
• Amlodipine
• Atenolol
• Hydralazine
• Sodium bicarbonate

Physical Examination

His blood pressure is elevated at 142/84, but otherwise his physical examination is unremarkable.

Chest X-ray

His chest X-ray is below (Figure 1).

Figure 1. PA (Panel A) and lateral (Panel B) chest x-ray.

The chest x-ray was interpreted as showing bilateral lower lobe nodules.

Which of the following is appropriate?

1. Obtain old chest x-rays for comparison
2. Spiral CT for pulmonary embolism
3. Coccidioidomycosis serology
4. A + C
5. All of the above

Reference as: Wesselius LJ. January 2013 pulmonary case of the month: maybe we should call GI. Southwest J Pulm Crit Care 2013;6(1):46-51. PDF