December 2022 Pulmonary Case of the Month: New Therapy for Mediastinal Disease

Thursday, December 1, 2022 at 8:00AM
Rick Robbins, M.D. in CT scan, PET scan, diagnosis, differential diagnosis, fibrosing mediastinitis, mediastinal calcification, rituximab, sclerosing mediastinitis, superior vena cava syndrome, treatment

Lewis J. Wesselius MD

Mayo Clinic Arizona

Scottsdale, AZ USA

 

History of Present Illness

A 43-year-old woman complained of persistent cough over 1 year with mild increasing dyspnea on exertion. She denied fever, sweats or weight loss. She had noted fatigue and dry cough, as well as shortness of breath, particularly when supine.

Past Medical History (PMH), Social History (SH), Family History (FH)

• An outside bronchoscopy done in 2019 with washings and biopsy showing only some non-specific inflammation
• Life-long nonsmoker
• Not on any chronic medications
• Had only lived in Arizona, although has travelled in other states
• There is no significant family history

Physical Examination

• Prominent vascularity on anterior chest

What should be done at this time? (Click on the correct answer to be directed to the 2nd of 6 pages)

1. Chest X-ray
2. Obtain old x-rays
3. Pulmonary function testing
4. Serology for coccidioidomycosis
5. All of the above

Article originally appeared on Southwest Journal of Pulmonary, Critical Care and Sleep (https://www.swjpcc.com/).