April 2025 Medical Image of the Month: An Unfortunate Case of Mimicry

By: Ali A, Abdulla M

Abstract: No abstract available. Manuscript truncated after 150 words. A 63-year-old African American woman with a 30-pack-year smoking history (quit 12 years prior) presented to the emergency room with a persistent cough, throat pain, significant weight loss (15 pounds over 6 months), exertional dyspnea, hoarseness, and fatigue. She denied dysphagia or GERD symptoms and had no other significant medical history. Over four months, she received three courses of antibiotics for presumed lobar pneumonia based on chest X-ray findings.  There was no significant clinical improvement, prompting her current visit to the ED.  The patient appeared ill and in discomfort. Her vital signs included a blood pressure of 108/73 mmHg (right arm, lying), pulse of 96 bpm, temperature of 99.3 °F (37.4 °C, oral), respiratory rate of 18 breaths/min, and SpO₂ of 91% on room air. Her BMI was 27 kg/m². Physical examination revealed a prominent right supraclavicular lymph node and diminished air entry at the right lung base with a …

URL: https://www.swjpcc.com/imaging/2025/4/2/april-2025-medical-image-of-the-month-an-unfortunate-case-of.html

April 2025 Critical Care Case of the Month: Being Decisive During a Difficult Treatment Dilemma

By: VonEssen SG

Abstract:

No abstract available. Article truncated after 150 words.

History of Present Illness

A 71-year-old woman was seen in the emergency department with acute onset of shortness of breath. The patient was well until 3 days prior to admission when she developed pain and swelling in her right calf and ankle. She self-treated with ibuprofen and elevation. She was improving until the afternoon of admission she developed fatigue, dyspnea on exertion, and shortness of breath and came to the emergency department.

Past Medical History

• Partial adrenal insufficiency after resection of pituitary tumor in 1992
• Growth hormone deficiency, treated with augmentation therapy
• Hypothyroidism due to pituitary tumor and Hashimoto’s thyroiditis
• Gastroesophageal reflux disease
• Prediabetic
• Hypertension
• Iron deficiency, treated with daily iron
• Colon polyps (adenomas)
• Gluteal tendinopathy, right hip
• COVID-19 a month prior to admission with minimal symptoms

Surgical History

• Appendectomy at age 16
• Resection of pituitary macroadenoma at age 38
• Operations for herniated lumbar disks at age 47, 49 and …

URL: https://www.swjpcc.com/critical-care/2025/4/1/april-2025-critical-care-case-of-the-month-being-decisive-du.html

March 2025 Medical Image of the Month: An Unusual Case of Pulmonary Infarction

By: Ali A

Abstract: No abstract available. Article truncated after 150 words. A 62-year-old woman with a history of hypertension, hypothyroidism, alcohol use, unexplained weight loss, and anorexia (for which she had been prescribed megestrol 3 months earlier) presented with alarming swelling in her left lower extremity. The swelling started in the left leg but progressively involved the entire left lower extremity over the course of a week. Patient also reported worsening chest pain and shortness of breathing starting 3 days prior to presentation. No cough or hemoptysis, no fevers or chills. She had a 45 pack-year smoking history. Her physical exam showed sinus tachycardia with heart rate 108 beats per minute, blood pressure 110/70 mm Hg, SpO2 was reading at 88% on room air. There was no jugular venous distention. Her heart sounds were normal, and her chest was clear upon auscultation. Patient was placed on supplemental oxygen. A chest X-ray (CXR) revealed mass-like cavitary lesions in both lungs. Routine laboratory …

URL: https://www.swjpcc.com/imaging/2025/3/2/march-2025-medical-image-of-the-month-an-unusual-case-of-pul.html

March 2025 Pulmonary Case of the Month: Interstitial Lung Disease of Uncertain Cause

By: Wesselius LJ

Abstract:

No abstract available. Manuscript truncated after 150 words. 

History of Present Illness

A 58-year-old man complained of gradually increasing shortness of breath. He denied any cough. An outside chest x-ray is reported as showing mild bilateral interstitial changes.

Past Medical History, Social History, and Family History

• He has a history of rheumatoid arthritis and has complaints of mild joint stiffness and soreness. He has taken mycophenolate for several years which has made no difference in his symptoms.
• He has never smoked and denies any occupational exposure.
• There is no family history of lung disease.

Physical Examination

• Vital Signs: SpO2 95% on room air but declined to 88% with ambulation.
• Chest: A few scattered inspiratory crackles noted.
• Cardiovascular: Regular rhythm without murmur.
• Extremities: No clubbing or edema. No evidence of synovitis or joint inflammation
• Skin: Slightly raised, pink, scaly lesions on elbows and knees.

Which of the following are indicated?

1. Dermatology consult
2. Pulmonary function testing
3. Connective ...

URL: https://www.swjpcc.com/pulmonary/2025/3/1/march-2025-pulmonary-case-of-the-month-interstitial-lung-dis.html

February 2025 Imaging Case of the Month: A Wolf in Sheep’s Clothing

By: Stib MT, Gotway MB

Abstract: 

No abstract available. Article truncated after 150 words. Clinical History: A 72-year-old man presents to his physician with chest pain. The patient awoke 2 weeks earlier with right-sided chest pain, thought to be the result of a pulled muscle. However, the pain did not remit over the next 2 weeks. The patient also complained of a mild cough productive of white sputum and some mild intermittent shortness of breath improving with albuterol. The patient denied fever.

The patient’s past medical history was remarkable for seasonal allergies, especially dust exposure, treated with fluticasone, and occasional wheezing, treated as needed with an albuterol inhaler. The patient was also diabetic and had hypertension and a history of hypothyroidism. The patient’s past surgical history included right knee total arthroplasty and lithotripsy for renal stones. The patient denied allergies, smoking, and illicit drug use. His medications included fluticasone, albuterol, amlodipine, atorvastatin, ramipril, sitagliptin-metformin, levothyroxine, and probiotics.   

The patient’s vital signs included a blood …

URL: https://www.swjpcc.com/imaging/2025/2/1/february-2025-imaging-case-of-the-month-a-wolf-in-sheeps-clo.html