July 2015 Imaging Case of the Month

Michael B. Gotway, MD

Department of Radiology 

Mayo Clinic Arizona

Scottsdale, AZ

Clinical History: A 40-year-old woman with a history of left breast malignancy diagnosed 11 years earlier, initially treated with lumpectomy, radiation, and chemotherapy (doxorubicin, cyclophosphamide, paclitaxel, followed by Herceptin), later treated with mastectomy following recurrence 2 years after diagnosis, presented with a several month history of upper respiratory infectious symptoms, including congestion, productive cough, and rhinorrhea. The patient also complained of some fatigue, although she was still active; she denied shortness of breath initially, but claimed that increasing breathlessness had developed more recently, limiting her exercise tolerance. The patient denied gastrointestinal, gynecological, musculoskeletal, or neurological complaints and no weight loss had occurred.

On admission to the hospital, her white blood cell count was mildly elevated at 14 x 10⁹ cells/L, with anemia as well (hemoglobin / hematocrit= 10 gm/dL / 28%, respectively). Her platelet count was also borderline decreased at 183 x 10⁹ cells/L. Electrolyte and liver panels showed normal values.

A frontal chest radiograph (Figure 1) was performed.

Figure 1. Frontal (A) and lateral (B) chest radiography.

Which of the following statements regarding the chest radiograph is most accurate? (Click on the correct answer to proceed to the second of six panels)

1. The frontal chest radiograph shows abnormal mediastinal contours
2. The frontal chest radiograph shows basal predominant fibrotic abnormalities
3. The frontal chest radiograph shows large lung volumes with a cystic appearance
4. The frontal chest radiograph shows mildly enlarged central pulmonary arteries
5. The frontal chest radiograph shows no abnormal findings

Reference as: Gotway MB. July 2015 imaging case of the month. Southwest J Pulm Crit Care. 2015;11(1):26-35. doi: http://dx.doi.org/10.13175/swjpcc090-15 PDF