April 2013 Pulmonary Case of the Month: A Suffocating Relationship

Lewis J. Wesselius, MD

Department of Pulmonary Medicine

Mayo Clinic Arizona

Scottsdale, AZ

History of Present Illness

A 70 year old woman from Oregon was referred by urology for evaluation of an abnormal thoracic CT scan. She was asymptomatic.

PMH, SH, FH

She has a prior history of retroperitoneal fibrosis with ureteral obstructions requiring stents and a transient ischemic attack in 2009. During 2012 she developed hypertension and a thoracic CT was done. She has never smoked and is a widowed housewife. There is no family history of lung disease, although her husband died from lung cancer. Her present medications include: amlodipine 10 mg/day, oxybutynin (Ditropan XL) 10 mg/day, and prednisone 5 mg daily.

Physical Examination

Her physical examination was unremarkable.

Radiography

Her chest CT scan is shown in Figure 1.

Figure 1. Thoracic CT movies from mediastinal windows (upper panel) and lung windows (lower panel).

Which of the following is true regarding the CT scan?

1. There is a right upper lobe mass
2. There are bilateral pleural effusions
3. There is lung fibrosis predominately involving the lower lobes
4. There are diffuse ground glass opacities
5. There are multiple pleural plaques

Reference as: Wesselius LJ. April 2013 pulmonary case of the month: a suffocating relationship. Southwest J Pulm Crit Care. 2013:6(4):154-60. PDF