Richard A. Robbins, MD
Phoenix Pulmonary and Critical Care Research and Education Foundation
Gilbert, AZ
History of Present Illness
A 77-year-old man underwent a thoracic CT scan for follow up of a known thoracic aneurysm. However, he had been feeling tired for about a week with a cough, night sweats and fever. He had no shortness of breath, wheezing or known history of lung disease.
Past Medical History, Social History and Family History
He has a history of hypertension and a known thoracic aortic aneurysm. There was a surgical repair of his right clavicle after a motor vehicle accident. He is single and has lived in Arizona for over 50 years. He just returned from a trip to California where he visited Disneyland. He does not smoke. Family history is noncontributory.
Current Medications
- Dutasteride
- Levothyroxine
- Atorvastatin
Physical Examination
His physical examination was reported as unremarkable. SpO2 was 95% on room air.
Radiography
Figure 1. Representative images from his thoracic CT scan showing a left lower lobe consolidation (red arrows). Panel A: coronal projection in lung windows. Panel B: axial view in lung windows.
Which of the following is appropriate at this time? (Click on the correct answer to proceed to the second of four panels)
- Begin empiric antibiotics
- Bronchoscopy with bronchoalveolar lavage
- Sputum Gram stain and culture
- 1 and 3
- All of the above
Reference as: Robbins RA. May 2015 pulmonary case of the month: pneumonia with a rash. Southwest J Pulm Crit Care. 2015;10(5):203-7. doi: http://dx.doi.org/10.13175/swjpcc044-15 PDF