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?
- Obtain old chest x-rays for comparison
- Spiral CT for pulmonary embolism
- Coccidioidomycosis serology
- A + C
- 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